Healthcare Provider Details

I. General information

NPI: 1215196837
Provider Name (Legal Business Name): BEDFORD DENTAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 MEETINGHOUSE RD
BEDFORD NH
03110-6090
US

IV. Provider business mailing address

207 MEETINGHOUSE RD
BEDFORD NH
03110-6090
US

V. Phone/Fax

Practice location:
  • Phone: 603-625-2193
  • Fax: 603-669-9100
Mailing address:
  • Phone: 603-625-2193
  • Fax: 603-669-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3482
License Number StateNH

VIII. Authorized Official

Name: DR. PAUL J CONNOLLY
Title or Position: PRESIDENT
Credential: DMD
Phone: 603-625-2193