Healthcare Provider Details

I. General information

NPI: 1164961611
Provider Name (Legal Business Name): SEACOAST CHILDREN'S DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 MARCH FARM WAY UNIT A
GREENLAND NH
03840
US

IV. Provider business mailing address

13 MARCH FARM WAY UNIT A
GREENLAND NH
03840
US

V. Phone/Fax

Practice location:
  • Phone: 603-319-4101
  • Fax:
Mailing address:
  • Phone: 603-319-4101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number03849
License Number StateNH

VIII. Authorized Official

Name: DR. ADAM JOASH BOTTRILL
Title or Position: PEDIATRIC DENTIST
Credential: D.M.D.
Phone: 603-319-4101