Healthcare Provider Details

I. General information

NPI: 1659145878
Provider Name (Legal Business Name): GATE CITY DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 MAIN STREET SUITE #411
NASHUA NH
03060
US

IV. Provider business mailing address

280 MAIN STREET SUITE #411
NASHUA NH
03060
US

V. Phone/Fax

Practice location:
  • Phone: 603-880-1707
  • Fax: 603-886-0914
Mailing address:
  • Phone: 603-880-1707
  • Fax: 603-886-0914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN R. WILBUR
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 603-880-1707