Healthcare Provider Details

I. General information

NPI: 1588770614
Provider Name (Legal Business Name): BRIAN EDWARD DAHLGREN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 ROUTE 125
BARRINGTON NH
03825-0249
US

IV. Provider business mailing address

PO BOX 249 RTE 125
BARRINGTON NH
03825-0249
US

V. Phone/Fax

Practice location:
  • Phone: 603-664-9940
  • Fax: 603-664-5461
Mailing address:
  • Phone: 603-664-2722
  • Fax: 603-664-5461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1630
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: