Healthcare Provider Details

I. General information

NPI: 1588634216
Provider Name (Legal Business Name): NADARAJAH GANESHKUMAR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 CENTRAL AVE STE K
DOVER NH
03820-3434
US

IV. Provider business mailing address

10 WALTERS WAY
EXETER NH
03833-4590
US

V. Phone/Fax

Practice location:
  • Phone: 781-296-0503
  • Fax:
Mailing address:
  • Phone: 781-296-0503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number03411
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: