Healthcare Provider Details

I. General information

NPI: 1376617019
Provider Name (Legal Business Name): ROY A CARSEN, D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

783 N MAIN ST
LACONIA NH
03246-2716
US

IV. Provider business mailing address

783 N MAIN ST
LACONIA NH
03246-2716
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-7404
  • Fax:
Mailing address:
  • Phone: 603-524-7404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1295
License Number StateNH

VIII. Authorized Official

Name: DR. ROY A CARSEN
Title or Position: ORTHODONTIST
Credential: DDS, MSD
Phone: 603-524-7404