Healthcare Provider Details

I. General information

NPI: 1437545829
Provider Name (Legal Business Name): LINCOLN PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 SOUTH MOUNTAIN RD.
LINCOLN NH
03251
US

IV. Provider business mailing address

PO BOX 699 25 SO. MTN. DR., A-3
LINCOLN NH
03251
US

V. Phone/Fax

Practice location:
  • Phone: 603-745-7266
  • Fax:
Mailing address:
  • Phone: 603-745-7266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number3561
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number3893
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number3970
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number3005
License Number StateNH
# 5
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number3985
License Number StateNJ

VIII. Authorized Official

Name: DR. PATRICK F. CAPOZZI
Title or Position: MANAGER
Credential: DDS
Phone: 603-745-7266