NPIMap

Organization Active NPI

Church Street Dental, PC

  • Dentist
  • Chicopee, MA
National Provider Identifier
1720405632
Registry record updated Mar 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
21848 Issued in MA
Legal business name
CHURCH STREET DENTAL, PC
Practice address
109 Church St Ste 1
Chicopee, MA 01020-1814
Phone
(214) 336-9767
NPI assigned
Mar 28, 2014
Last updated
Mar 28, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ranganayaki Chirumamilla
Title
President
Phone
(214) 336-9767

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 21848 MA Primary

Addresses

Primary practice location

109 Church St Ste 1
Chicopee, MA 01020-1814

Mailing address

109 Church St Ste 1
Chicopee, MA 01020-1814
Phone (214) 336-9767

National Provider Directory

National Provider Directory

Locations

109 Church St
#1
Chicopee, MA 01020
Phone (214) 336-9767

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395964800000",
    "number": "1720405632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 CHURCH ST STE 1",
            "city": "CHICOPEE",
            "state": "MA",
            "postal_code": "010201814",
            "telephone_number": "214-336-9767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 CHURCH ST STE 1",
            "city": "CHICOPEE",
            "state": "MA",
            "postal_code": "010201814",
            "telephone_number": "214-336-9767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHURCH STREET DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-28",
        "last_updated": "2014-03-28",
        "status": "A",
        "authorized_official_last_name": "CHIRUMAMILLA",
        "authorized_official_first_name": "RANGANAYAKI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-336-9767"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "21848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicopee, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.