Healthcare Provider Details

I. General information

NPI: 1184087058
Provider Name (Legal Business Name): ALLURE DENTAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S MAIN ST
MANCHESTER NH
03102-4405
US

IV. Provider business mailing address

5 MOUNT ROYAL AVE SUITE 300
MARLBOROUGH MA
01752-1981
US

V. Phone/Fax

Practice location:
  • Phone: 603-384-3455
  • Fax:
Mailing address:
  • Phone: 508-460-0632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. JOANNE TAVANO
Title or Position: COO
Credential:
Phone: 978-580-1524