Healthcare Provider Details

I. General information

NPI: 1225748072
Provider Name (Legal Business Name): HALEY CHRISTINE O'CONNELL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

668 CENTRAL AVE
DOVER NH
03820-3414
US

IV. Provider business mailing address

668 CENTRAL AVE
DOVER NH
03820-3414
US

V. Phone/Fax

Practice location:
  • Phone: 603-749-3013
  • Fax:
Mailing address:
  • Phone: 603-749-3013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number03286
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: