Healthcare Provider Details

I. General information

NPI: 1194895342
Provider Name (Legal Business Name): LARRY JOSEPH PUCCINI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 RIVERWAY PL
BEDFORD NH
03110-6766
US

IV. Provider business mailing address

505 RIVERWAY PL
BEDFORD NH
03110-6766
US

V. Phone/Fax

Practice location:
  • Phone: 603-622-3445
  • Fax: 603-624-4340
Mailing address:
  • Phone: 603-622-3445
  • Fax: 603-624-4340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1979
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: