Healthcare Provider Details

I. General information

NPI: 1083087423
Provider Name (Legal Business Name): SIMPLY ORTHODONTICS, NH, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

49 DERRY ST
HUDSON NH
03051-4027
US

IV. Provider business mailing address

49 DERRY ST
HUDSON NH
03051-4027
US

V. Phone/Fax

Practice location:
  • Phone: 603-889-1100
  • Fax:
Mailing address:
  • Phone: 603-889-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number03377
License Number StateNH

VIII. Authorized Official

Name: HOUSSAM ALKHOURY
Title or Position: PRESIDENT
Credential:
Phone: 603-889-1100