Healthcare Provider Details

I. General information

NPI: 1770081606
Provider Name (Legal Business Name): NG ENTERPRISES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2018
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:
  • 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: DR. NADARAJAH GANESHKUMAR
Title or Position: DENTIST
Credential: DMD
Phone: 781-296-0503