Healthcare Provider Details

I. General information

NPI: 1407133234
Provider Name (Legal Business Name): SHAUNA L.GAUTHIER DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 HIGH ST
LACONIA NH
03246-3537
US

IV. Provider business mailing address

96 HIGH ST
LACONIA NH
03246-3537
US

V. Phone/Fax

Practice location:
  • Phone: 603-527-1700
  • Fax: 603-527-1785
Mailing address:
  • Phone: 603-527-1700
  • Fax: 603-527-1785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number03806
License Number StateNH

VIII. Authorized Official

Name: SHAUNA L GAUTHIER
Title or Position: OWNER
Credential: DMD
Phone: 603-527-1700