Healthcare Provider Details

I. General information

NPI: 1164607172
Provider Name (Legal Business Name): IRINA ADLER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CANTON ST STE 12
MANCHESTER NH
03103-3524
US

IV. Provider business mailing address

30 CANTON ST STE 12
MANCHESTER NH
03103-3524
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3946
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: