Healthcare Provider Details

I. General information

NPI: 1861890410
Provider Name (Legal Business Name): ULYIMATE DENTAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 S MAIN ST
CONCORD NH
03301-3483
US

IV. Provider business mailing address

410 S MAIN ST
CONCORD NH
03301-3483
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-1851
  • Fax: 603-224-7240
Mailing address:
  • Phone: 603-224-1851
  • Fax: 603-224-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. MOSTAFA H. EL-SHERIF
Title or Position: MANAGER
Credential: DMD,MSCD,PHD
Phone: 603-731-0100