| Hampden County Oral Surgery Pllc | |
|
664 College Hwy Southwick MA 01077-9260 | |
| (413) 642-5250 | |
| (413) 831-6366 |
| Full Name | Hampden County Oral Surgery Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 664 College Hwy, Southwick, Massachusetts |
| Authorized Official Name and Position | Jonathan Charles Sudol (OWNER) |
| Authorized Official Contact | 4136425250 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hampden County Oral Surgery Pllc Po Box 1146 Southwick MA 01077-1146 Ph: () - | Hampden County Oral Surgery Pllc 664 College Hwy Southwick MA 01077-9260 Ph: (413) 642-5250 |
| NPI Number | 1578270039 |
|---|---|
| Provider Enumeration Date | 11/03/2022 |
| Last Update Date | 05/11/2023 |
| Medicare PECOS PAC ID | 7214308550 |
|---|---|
| Medicare Enrollment ID | O20230124000859 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578270039 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Jonathan C Sudol |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1033222583 PECOS PAC ID: 2365453818 Enrollment ID: I20060511000274 |
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