Healthcare Provider Details

I. General information

NPI: 1922100379
Provider Name (Legal Business Name): ROCCO RAFFAELE ADDANTE D.M.D., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DARTMOUTH HITCHCOCK MEDICAL CENTER -ORAL SURGERY
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DARTMOUTH HITCHCOCK MEDICAL CENTER -ORAL SURGERY
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5150
  • Fax:
Mailing address:
  • Phone: 603-650-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number6297
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number01684
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: