Healthcare Provider Details

I. General information

NPI: 1356564595
Provider Name (Legal Business Name): NOMITH RAMDEV DMD, MSD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 SILVER ST
DOVER NH
03820-3921
US

IV. Provider business mailing address

69 SILVER ST
DOVER NH
03820-3921
US

V. Phone/Fax

Practice location:
  • Phone: 603-742-4123
  • Fax:
Mailing address:
  • Phone: 603-742-4123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3524
License Number StateNH

VIII. Authorized Official

Name: DR. NOMITH THULA RAMDEV
Title or Position: OWNER
Credential: DMD, MSD
Phone: 603-742-4123