| Western Mass Periodontics PC | |
|
20 W Avon Rd Ste 101 Avon CT 06001-3677 | |
| (860) 673-0451 | |
| Not Available |
| Full Name | Western Mass Periodontics PC |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 20 W Avon Rd Ste 101, Avon, Connecticut |
| Authorized Official Name and Position | Leah Ann Maylott (CREDENTIALING ADMINISTRATOR) |
| Authorized Official Contact | 8608748198 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Western Mass Periodontics PC 65 Elm St Worcester MA 01609-2547 | Western Mass Periodontics PC 20 W Avon Rd Ste 101 Avon CT 06001-3677 Ph: (860) 673-0451 |
| NPI Number | 1467085407 |
|---|---|
| Provider Enumeration Date | 02/18/2020 |
| Last Update Date | 01/18/2022 |
| Certification Date | 01/12/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467085407 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | () | Primary |
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