Healthcare Provider Details

I. General information

NPI: 1932264686
Provider Name (Legal Business Name): MARY DALLIN HUNTING CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 NEW ROCHESTER RD SUITE 2
DOVER NH
03820-8800
US

IV. Provider business mailing address

113 NEW ROCHESTER RD SUITE 2
DOVER NH
03820-8800
US

V. Phone/Fax

Practice location:
  • Phone: 603-742-6555
  • Fax: 603-742-2908
Mailing address:
  • Phone: 603-742-6555
  • Fax: 603-742-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA482
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: