Healthcare Provider Details

I. General information

NPI: 1346633906
Provider Name (Legal Business Name): AMY KOUKKARI RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MARKET PL
HOLLIS NH
03049-5974
US

IV. Provider business mailing address

3 MARKET PL
HOLLIS NH
03049-5974
US

V. Phone/Fax

Practice location:
  • Phone: 603-465-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number02583
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: