MEDICARE: MCWILLIAMS AND WONSAVAGE DENTISTRY PARTNERSHIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1677	NH

General Provider Information

NPI Number	:	1376712828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCWILLIAMS AND WONSAVAGE DENTISTRY PARTNERSHIP

Provider Business Mailing Address
First Line	:	71 LYME RD
Second Line	:
City	:	HANOVER
State	:	NH
Zip	:	03755-1253
Country	:	US
Telephone Number	:	603-643-3104
Fax Number	:	603-643-0241

Provider Business Practice Location Address
First Line	:	71 LYME RD
Second Line	:
City	:	HANOVER
State	:	NH
Zip	:	03755-1253
Country	:	US
Telephone Number	:	603-643-3104
Fax Number	:	603-643-0241

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. ROGER W MCWILLIAMS
Credential	:	D.M.D., PH.D.
Telephone Number	:	603-643-3104

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	02/28/2008

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