Provider Demographics
NPI:1134716640
Name:MAXILLOFACIAL & IMPLANT SURGERY OF WESTERN MASS PC
Entity type:Organization
Organization Name:MAXILLOFACIAL & IMPLANT SURGERY OF WESTERN MASS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:413-525-0100
Mailing Address - Street 1:382 N MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1830
Mailing Address - Country:US
Mailing Address - Phone:413-525-1000
Mailing Address - Fax:413-525-8608
Practice Address - Street 1:382 N MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-1830
Practice Address - Country:US
Practice Address - Phone:413-525-0100
Practice Address - Fax:413-525-8608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty