Healthcare Provider Details

I. General information

NPI: 1730708272
Provider Name (Legal Business Name): ALTON BAY DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 09/02/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 MAIN STREET
ALTON NH
03809
US

IV. Provider business mailing address

PO BOX 1584
ALTON NH
03809
US

V. Phone/Fax

Practice location:
  • Phone: 603-855-2017
  • Fax:
Mailing address:
  • Phone: 207-316-3328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CURTIS ALAN THIBEAULT
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 207-316-3328