Healthcare Provider Details

I. General information

NPI: 1629303086
Provider Name (Legal Business Name): DENTAL ARTS OF BEDFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 S RIVER RD BEDFORD PLACE UNIT #33
BEDFORD NH
03110-6719
US

IV. Provider business mailing address

40 S RIVER RD BEDFORD PLACE UNIT #33
BEDFORD NH
03110-6719
US

V. Phone/Fax

Practice location:
  • Phone: 603-647-2278
  • Fax: 603-622-1616
Mailing address:
  • Phone: 603-647-2278
  • Fax: 603-622-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3118
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3535
License Number StateNH

VIII. Authorized Official

Name: MRS. LORI J ROLKE
Title or Position: OFFICE MANAGER
Credential:
Phone: 603-647-2278