Healthcare Provider Details

I. General information

NPI: 1205005329
Provider Name (Legal Business Name): LAKES REGION DENTAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 COUNTRY CLUB RD VILLAGE WEST BLD 4
GILFORD NH
03249-6972
US

IV. Provider business mailing address

PO BOX 7325
GILFORD NH
03247-7325
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-8250
  • Fax: 603-524-2149
Mailing address:
  • Phone: 603-524-8250
  • Fax: 603-524-2149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2618
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number2618
License Number StateNH

VIII. Authorized Official

Name: HELEN M BECKER
Title or Position: OFFICE MANAGER
Credential:
Phone: 603-524-8250