Healthcare Provider Details

I. General information

NPI: 1164054417
Provider Name (Legal Business Name): CHILDREN'S DENTISTRY OF DUBLIN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1283 MAIN ST
DUBLIN NH
03444-8242
US

IV. Provider business mailing address

1283 MAIN ST
DUBLIN NH
03444-8242
US

V. Phone/Fax

Practice location:
  • Phone: 603-563-9969
  • Fax:
Mailing address:
  • Phone: 603-563-9969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN D COLLINS JR.
Title or Position: OFFICE MANAGER
Credential:
Phone: 603-563-9969