Healthcare Provider Details

I. General information

NPI: 1790514016
Provider Name (Legal Business Name): THALIA DE JESUS DAIN L.AC., LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314B CENTRAL AVE
DOVER NH
03820-4133
US

IV. Provider business mailing address

6 ROSS RD
ROLLINSFORD NH
03869-5910
US

V. Phone/Fax

Practice location:
  • Phone: 603-534-2334
  • Fax:
Mailing address:
  • Phone: 603-534-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number332
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8267
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: