Healthcare Provider Details

I. General information

NPI: 1093253387
Provider Name (Legal Business Name): MICHELLE DESBIENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CLINTON ST
CONCORD NH
03301-2310
US

IV. Provider business mailing address

75 CLINTON ST
CONCORD NH
03301-2310
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-4061
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number00861
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: