Healthcare Provider Details

I. General information

NPI: 1619912086
Provider Name (Legal Business Name): ALBERT EDWARD ST GERMAIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 MAIN DUNSTABLE RD
NASHUA NH
03060-3640
US

IV. Provider business mailing address

155 MAIN DUNSTABLE RD
NASHUA NH
03060-3640
US

V. Phone/Fax

Practice location:
  • Phone: 603-883-0833
  • Fax: 603-669-9100
Mailing address:
  • Phone: 603-883-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3021
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: