Healthcare Provider Details

I. General information

NPI: 1003202490
Provider Name (Legal Business Name): LINDA CAROL MARSHALL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 PLEASANT ST, SUITE 202 SUMMIT DENTAL
CONCORD NH
03304
US

IV. Provider business mailing address

248 PLEASANT ST, SUITE 202 SUMMIT DENTAL
CONCORD NH
03304
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-7878
  • Fax:
Mailing address:
  • Phone: 603-228-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number01152
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: