Healthcare Provider Details

I. General information

NPI: 1417114687
Provider Name (Legal Business Name): NORTH MANCHESTER ORAL AND MAXILLOFACIAL SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 SAGAMORE ST
MANCHESTER NH
03104-3547
US

IV. Provider business mailing address

27 SAGAMORE ST
MANCHESTER NH
03104-3547
US

V. Phone/Fax

Practice location:
  • Phone: 603-622-9441
  • Fax: 603-622-9738
Mailing address:
  • Phone: 603-622-9441
  • Fax: 603-622-9738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2640
License Number StateNH

VIII. Authorized Official

Name: DR. MARK GERARD HOCHBERG
Title or Position: OWNER
Credential: DMD
Phone: 603-622-9441