Healthcare Provider Details

I. General information

NPI: 1366155251
Provider Name (Legal Business Name): CENTER FOR DENTAL EXCELLENCE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 NORTHEASTERN BLVD STE 19
NASHUA NH
03062-3192
US

IV. Provider business mailing address

74 NORTHEASTERN BLVD STE 19
NASHUA NH
03062-3192
US

V. Phone/Fax

Practice location:
  • Phone: 603-886-5500
  • Fax: 603-886-5544
Mailing address:
  • Phone: 603-886-5500
  • Fax: 603-886-5544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN C URA
Title or Position: PRESIDENT/CEO
Credential: DDS
Phone: 603-886-5500