Healthcare Provider Details

I. General information

NPI: 1346640885
Provider Name (Legal Business Name): ROBERT MISKIMEN III DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E BROADWAY UNIT 1
DERRY NH
03038-2401
US

IV. Provider business mailing address

410 S MAIN ST
CONCORD NH
03301-3483
US

V. Phone/Fax

Practice location:
  • Phone: 603-945-1287
  • Fax:
Mailing address:
  • Phone: 603-609-7467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number04623
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: