Healthcare Provider Details

I. General information

NPI: 1770795858
Provider Name (Legal Business Name): FREDRICK M. VEGA, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 PINEWOOD ROAD
ALLENSTOWN NH
03275
US

IV. Provider business mailing address

PO BOX 165
SUNCOOK NH
03275
US

V. Phone/Fax

Practice location:
  • Phone: 603-485-8464
  • Fax:
Mailing address:
  • Phone: 603-485-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number1857
License Number StateNH

VIII. Authorized Official

Name: DR. FREDRICK M VEGA
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 603-485-8464