Healthcare Provider Details

I. General information

NPI: 1326251935
Provider Name (Legal Business Name): WILLLIAM A. MEHAN, DMD PROFESSIONAL ASSOC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 MAMMOTH RD
MANCHESTER NH
03109-4337
US

IV. Provider business mailing address

113 MAMMOTH RD
MANCHESTER NH
03109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 603-623-8003
  • Fax: 603-623-1191
Mailing address:
  • Phone: 603-623-8003
  • Fax: 603-623-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1423
License Number StateNH

VIII. Authorized Official

Name: DR. WILLIAM A. MEHAN
Title or Position: PRESIDENT
Credential: DMD
Phone: 603-623-8003