Healthcare Provider Details

I. General information

NPI: 1326164971
Provider Name (Legal Business Name): GRANITE STATE HEARING AID CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 STARK ST
MANCHESTER NH
03101-1935
US

IV. Provider business mailing address

25 STARK ST
MANCHESTER NH
03101-1935
US

V. Phone/Fax

Practice location:
  • Phone: 603-627-1762
  • Fax: 603-623-1299
Mailing address:
  • Phone: 603-627-1762
  • Fax: 603-623-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number156
License Number StateNH

VIII. Authorized Official

Name: MR. DAVID DACHOWSKI
Title or Position: OWNER
Credential:
Phone: 603-627-1762