1720203292 NPI number — EDWARD SMOLA DMD

Table of content: (NPI 1720203292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720203292 NPI number — EDWARD SMOLA DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD SMOLA DMD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720203292
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
63 EAST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HADLEY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01035-9790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-584-6557
Provider Business Mailing Address Fax Number:
413-584-3462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63 EAST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HADLEY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01035-9790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-584-6557
Provider Business Practice Location Address Fax Number:
413-584-3462
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMOLA
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER DENTIST
Authorized Official Telephone Number:
413-584-6557

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  10552 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 020010552MA01 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 845318 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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