Healthcare Provider Details

I. General information

NPI: 1912176744
Provider Name (Legal Business Name): MONADNOCK DENTAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 MAIN STREET
JAFFREY NH
03452
US

IV. Provider business mailing address

123 MAIN STREET
JAFFREY NH
03452
US

V. Phone/Fax

Practice location:
  • Phone: 603-532-8720
  • Fax: 603-532-5618
Mailing address:
  • Phone: 603-532-8720
  • Fax: 603-532-5618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MR. ZANE TYLER BROOME
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 603-532-8720