Healthcare Provider Details

I. General information

NPI: 1528072550
Provider Name (Legal Business Name): RICHARD C OSOFSKY DMD PROF ASSN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 PLEASANT STREET
MANCHESTER NH
03101-2319
US

IV. Provider business mailing address

73 PLEASANT STREET
MANCHESTER NH
03101-2319
US

V. Phone/Fax

Practice location:
  • Phone: 603-622-5841
  • Fax: 603-622-5841
Mailing address:
  • Phone: 603-622-5841
  • Fax: 603-622-5841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1257
License Number StateNH

VIII. Authorized Official

Name: RICHARD CHARLES OSOFSKY
Title or Position: PRESIDENT
Credential: DMD
Phone: 603-622-5841