Healthcare Provider Details

I. General information

NPI: 1467062935
Provider Name (Legal Business Name): MANCHESTER ORAL SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2020
Last Update Date: 08/08/2020
Certification Date: 08/08/2020
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 Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK D ABEL
Title or Position: SOLE MEMBER
Credential: DMD, MD
Phone: 603-622-9441