Healthcare Provider Details

I. General information

NPI: 1134337751
Provider Name (Legal Business Name): ROBERT A FREMEAU DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CANTON ST SUITE 12
MANCHESTER NH
03103-3524
US

IV. Provider business mailing address

10 SUNRISE BLVD
HOOKSETT NH
03106-2606
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-6434
  • Fax:
Mailing address:
  • Phone: 603-668-6356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number1444
License Number StateNH

VIII. Authorized Official

Name: ALISON SMITH
Title or Position: OFFICE MANAGER
Credential:
Phone: 603-668-6434