Healthcare Provider Details

I. General information

NPI: 1760551030
Provider Name (Legal Business Name): STEPHEN SCIARRIO DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MADISON AVE
HOOKSETT NH
03106-1944
US

IV. Provider business mailing address

2 MADISON AVE
HOOKSETT NH
03106-1944
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-5333
  • Fax: 603-624-4030
Mailing address:
  • Phone: 603-668-5333
  • Fax: 603-624-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3010
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier30011442
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer

VIII. Authorized Official

Name: DR. STEPHEN GERARD SCIARRIO
Title or Position: MEMBER
Credential: DDS
Phone: 603-668-5333