Healthcare Provider Details

I. General information

NPI: 1265622039
Provider Name (Legal Business Name): ALAN KENNELL, DDS, MS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 07/27/2007
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 Code261QD0000X
TaxonomyDental Clinic/Center
License Number03519
License Number StateNH

VIII. Authorized Official

Name: DR. ALAN F KENNELL
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 603-524-7404