Healthcare Provider Details

I. General information

NPI: 1780711481
Provider Name (Legal Business Name): DOVER FOOT SPECIALTY CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 10/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 CENTRAL AVE SUITE J
DOVER NH
03820-3434
US

IV. Provider business mailing address

750 CENTRAL AVE SUITE J
DOVER NH
03820-3434
US

V. Phone/Fax

Practice location:
  • Phone: 603-742-2245
  • Fax: 603-742-0712
Mailing address:
  • Phone: 603-742-2245
  • Fax: 603-742-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0187
License Number StateNH

VIII. Authorized Official

Name: WAYNE C GOULD
Title or Position: CEO
Credential: DPM
Phone: 603-742-2245