NPIMap

Organization Active NPI

Western Mass Dental Specialty Springfield PC

  • Periodontics
  • Agawam, MA
National Provider Identifier
1790591113
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
WESTERN MASS DENTAL SPECIALTY SPRINGFIELD PC
Practice address
158 Main St
Agawam, MA 01001-1803
Phone
(413) 786-2341
NPI assigned
Dec 10, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

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

Authorized official

Name
Christine Branigan
Title
Credentialing Manager
Phone
(631) 696-0100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X Primary

Addresses

Primary practice location

158 Main St
Agawam, MA 01001-1803

Mailing address

158 Main St
Agawam, MA 01001-1803
Phone (413) 786-2341

National Provider Directory

National Provider Directory
Tax ID family
Western Mass Dental Specialty Springfield PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1733788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733788800000",
    "number": "1790591113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 MAIN ST",
            "city": "AGAWAM",
            "state": "MA",
            "postal_code": "010011803",
            "telephone_number": "413-786-2341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 MAIN ST",
            "city": "AGAWAM",
            "state": "MA",
            "postal_code": "010011803",
            "telephone_number": "413-786-2341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN MASS DENTAL SPECIALTY SPRINGFIELD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-10",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A",
        "authorized_official_last_name": "BRANIGAN",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "631-696-0100"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Agawam, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; 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.