Healthcare Provider Details

I. General information

NPI: 1255907945
Provider Name (Legal Business Name): OMG SMILES NH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 ELM ST
MANCHESTER NH
03101-2701
US

IV. Provider business mailing address

31 BARTLET ST
ANDOVER MA
01810-3810
US

V. Phone/Fax

Practice location:
  • Phone: 508-827-8887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: AMY BUCHLER
Title or Position: ORTHODONTIST
Credential:
Phone: 209-499-4882