Healthcare Provider Details

I. General information

NPI: 1699952754
Provider Name (Legal Business Name): ADVANCED FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 AMHERST ST
NASHUA NH
03063-1017
US

IV. Provider business mailing address

613 AMHERST ST
NASHUA NH
03063-1017
US

V. Phone/Fax

Practice location:
  • Phone: 603-882-3885
  • Fax:
Mailing address:
  • Phone: 603-882-3885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: ROGER W ENGLAND
Title or Position: OWNER
Credential:
Phone: 603-882-3885