Healthcare Provider Details

I. General information

NPI: 1003029679
Provider Name (Legal Business Name): RICHARD NIEDERMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 03/12/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DELTA DR #302
CONCORD NH
03301
US

IV. Provider business mailing address

2 DELTA DR #302
CONCORD NH
03301
US

V. Phone/Fax

Practice location:
  • Phone: 917-280-5920
  • Fax: 617-262-4021
Mailing address:
  • Phone: 917-280-5920
  • Fax: 617-262-4021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number13692
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number05001
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: