Healthcare Provider Details

I. General information

NPI: 1417162967
Provider Name (Legal Business Name): DONALD M. HUMEN, DMD,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 RIVERSIDE STREET
NASHUA NH
03062
US

IV. Provider business mailing address

29 RIVERSIDE STREET
NASHUA NH
03062
US

V. Phone/Fax

Practice location:
  • Phone: 603-882-6100
  • Fax: 603-882-5106
Mailing address:
  • Phone: 603-882-6100
  • Fax: 603-882-5106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1211
License Number StateNH

VIII. Authorized Official

Name: DR. DONALD M. HUMEN
Title or Position: PRESIDENT
Credential: DMD
Phone: 603-882-6100