Healthcare Provider Details

I. General information

NPI: 1255671178
Provider Name (Legal Business Name): SEASIDE SMILES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 03/20/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 MAIN ST.
ALTON NH
03809-1498
US

IV. Provider business mailing address

PO BOX 1498
ALTON NH
03809-1498
US

V. Phone/Fax

Practice location:
  • Phone: 603-280-4500
  • Fax: 603-632-3620
Mailing address:
  • Phone: 603-280-4500
  • Fax: 603-632-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN17086
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW HALL
Title or Position: BUSINESS MANAGER
Credential:
Phone: 603-280-4500