Healthcare Provider Details

I. General information

NPI: 1144272352
Provider Name (Legal Business Name): CONCORD ORAL SURGERY PROFESSIONAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 PLEASANT ST SUITE 13
CONCORD NH
03301-2952
US

IV. Provider business mailing address

194 PLEASANT ST SUITE 13
CONCORD NH
03301-2952
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-3482
  • Fax: 603-224-2331
Mailing address:
  • Phone: 603-225-3482
  • Fax: 603-224-2331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2186
License Number StateNH

VIII. Authorized Official

Name: DR. MARK M. SCURA
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 603-225-3482