Healthcare Provider Details

I. General information

NPI: 1497825491
Provider Name (Legal Business Name): CONCORD PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 PLEASANT ST SUITE 1800
CONCORD NH
03301-2588
US

IV. Provider business mailing address

248 PLEASANT ST SUITE 1800
CONCORD NH
03301-2588
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-3339
  • Fax: 603-224-3330
Mailing address:
  • Phone: 603-224-3339
  • Fax: 603-224-3330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3005
License Number StateNH

VIII. Authorized Official

Name: DR. ROGER A ACHONG
Title or Position: PEDIATRIC DENTIST
Credential: DMD
Phone: 603-224-3339