Healthcare Provider Details

I. General information

NPI: 1588695316
Provider Name (Legal Business Name): CENTRAL NEW HAMPSHIRE ORAL SURGERY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 N STATE ST
CONCORD NH
03301-5020
US

IV. Provider business mailing address

187 N STATE ST
CONCORD NH
03301-5020
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-9050
  • Fax: 603-229-0237
Mailing address:
  • Phone: 603-228-9050
  • Fax: 603-229-0237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. LYNDA A LEVY
Title or Position: BUSINESS MANAGER
Credential:
Phone: 603-228-9050