Healthcare Provider Details

I. General information

NPI: 1194733691
Provider Name (Legal Business Name): CATHOLIC MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MCGREGOR ST POISSON DENTAL FACILITY
MANCHESTER NH
03102-3730
US

IV. Provider business mailing address

100 MCGREGOR ST POISSON DENTAL FACILITY
MANCHESTER NH
03102-3730
US

V. Phone/Fax

Practice location:
  • Phone: 603-663-6226
  • Fax: 603-663-7800
Mailing address:
  • Phone: 603-663-6226
  • Fax: 603-663-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number StateNH

VIII. Authorized Official

Name: MR. PAUL A MERTZIC
Title or Position: DIRECTOR, COMMUNITY HEALTH SERVICES
Credential: RN
Phone: 603-663-8709