Provider Demographics
NPI:1841862075
Name:DR SCOLLARD & ASSOCIATES FAMILY DENTISTRY PLLC
Entity type:Organization
Organization Name:DR SCOLLARD & ASSOCIATES FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOLLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-921-9793
Mailing Address - Street 1:18 SANDALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1544
Mailing Address - Country:US
Mailing Address - Phone:225-921-9793
Mailing Address - Fax:
Practice Address - Street 1:46 DAGGETT DR STE 2C
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4646
Practice Address - Country:US
Practice Address - Phone:413-747-9224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental