Healthcare Provider Details

I. General information

NPI: 1679640130
Provider Name (Legal Business Name): MARTIN LEO CHAPUT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 WHITE MOUNTAIN HWY
CONWAY NH
03818-4204
US

IV. Provider business mailing address

209 PEQUAWKET TRL
FREEDOM NH
03836-4435
US

V. Phone/Fax

Practice location:
  • Phone: 603-447-8900
  • Fax:
Mailing address:
  • Phone: 603-539-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number03517
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: