Provider Demographics
NPI:1245013564
Name:MOBILE DENTAL HYGIENE SERVICES OF WESTERN MASS, LLC
Entity type:Organization
Organization Name:MOBILE DENTAL HYGIENE SERVICES OF WESTERN MASS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DENTAL HYGIENIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MANDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:508-341-1599
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:BRIMFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01010-0103
Mailing Address - Country:US
Mailing Address - Phone:508-341-1599
Mailing Address - Fax:
Practice Address - Street 1:359 BROOKFIELD RD
Practice Address - Street 2:
Practice Address - City:BRIMFIELD
Practice Address - State:MA
Practice Address - Zip Code:01010-9676
Practice Address - Country:US
Practice Address - Phone:508-341-1599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty