Healthcare Provider Details

I. General information

NPI: 1790998169
Provider Name (Legal Business Name): SUMMIT ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 02/12/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRAFALGAR SQUARE
NASHUA NH
03063
US

IV. Provider business mailing address

1 TRAFALGAR SQUARE
NASHUA NH
03063
US

V. Phone/Fax

Practice location:
  • Phone: 603-882-2101
  • Fax: 603-882-3803
Mailing address:
  • Phone: 603-882-2101
  • Fax: 603-882-3803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1835
License Number StateNH

VIII. Authorized Official

Name: AMITABHA LALA
Title or Position: OWNER-ORTHODONTIST
Credential:
Phone: 603-882-2101