Healthcare Provider Details

I. General information

NPI: 1841615994
Provider Name (Legal Business Name): JAMES ANTHONY TEEBAGY D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 PLEASANT ST
CONCORD NH
03301-2944
US

IV. Provider business mailing address

21 BRIER LN
DERRY NH
03038-4844
US

V. Phone/Fax

Practice location:
  • Phone: 603-522-5242
  • Fax:
Mailing address:
  • Phone: 781-367-3866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number04554
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: