Healthcare Provider Details

I. General information

NPI: 1457426686
Provider Name (Legal Business Name): CORNERSTONE PERIODONTICS AND IMPLANTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 MANCHESTER ST SUITE 5
CONCORD NH
03301
US

IV. Provider business mailing address

153 MANCHESTER ST SUITE 5
CONCORD NH
03301
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-9474
  • Fax: 603-224-9232
Mailing address:
  • Phone: 603-224-9474
  • Fax: 603-224-9232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3290
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3289
License Number StateNH

VIII. Authorized Official

Name: AUSTIN H WANG
Title or Position: PERIODONTIST OWNER
Credential:
Phone: 603-224-9474