Healthcare Provider Details

I. General information

NPI: 1295387140
Provider Name (Legal Business Name): CONCORD ORTHODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 FOUNDRY ST STE 202
CONCORD NH
03301-5431
US

IV. Provider business mailing address

16 FOUNDRY ST STE 202
CONCORD NH
03301-5431
US

V. Phone/Fax

Practice location:
  • Phone: 603-333-2538
  • Fax:
Mailing address:
  • Phone: 603-333-2538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JAMIE CASWELL YOUNG
Title or Position: BUSINESS MANAGER
Credential:
Phone: 603-224-3339