Healthcare Provider Details

I. General information

NPI: 1912312190
Provider Name (Legal Business Name): JASON J PEACOCK DDS, MS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 LOUDON RD SUITE 202
CONCORD NH
03301-5345
US

IV. Provider business mailing address

6 LOUDON RD SUITE 202
CONCORD NH
03301-5345
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-1066
  • Fax: 603-228-5305
Mailing address:
  • Phone: 603-228-1066
  • Fax: 603-228-5305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number03968
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number03968
License Number StateNH

VIII. Authorized Official

Name: JASON J PEACOCK
Title or Position: DENTIST/OWNER
Credential: DDS, MS
Phone: 603-228-1066