Healthcare Provider Details

I. General information

NPI: 1912579053
Provider Name (Legal Business Name): LONDON FAMILY ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 RIVERWAY PL
BEDFORD NH
03110-6766
US

IV. Provider business mailing address

502 RIVERWAY PL
BEDFORD NH
03110-6766
US

V. Phone/Fax

Practice location:
  • Phone: 603-622-2100
  • Fax: 603-622-5665
Mailing address:
  • Phone: 603-622-2100
  • Fax: 603-622-5665

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: DR. DANIELLE LONDON
Title or Position: OWNER, ORTHODONTIST
Credential: DDS, MS
Phone: 603-622-2100