Healthcare Provider Details

I. General information

NPI: 1356180327
Provider Name (Legal Business Name): TONI ONSY GHABRIAL SHENODA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 VINTON ST
MANCHESTER NH
03103-3928
US

IV. Provider business mailing address

8 VINTON ST
MANCHESTER NH
03103-3928
US

V. Phone/Fax

Practice location:
  • Phone: 551-200-7855
  • Fax:
Mailing address:
  • Phone: 551-200-7855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number05362
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDL101406
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: