Provider Demographics
NPI:1548500309
Name:TAYLOR STREET DENTAL ASSOCIATES
Entity type:Organization
Organization Name:TAYLOR STREET DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:I
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:413-781-7645
Mailing Address - Street 1:174 WORTHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1220
Mailing Address - Country:US
Mailing Address - Phone:413-781-7645
Mailing Address - Fax:413-736-3476
Practice Address - Street 1:174 WORTHINGTON ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1220
Practice Address - Country:US
Practice Address - Phone:413-781-7645
Practice Address - Fax:413-736-3476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN15792122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty