Healthcare Provider Details

I. General information

NPI: 1467500520
Provider Name (Legal Business Name): NASHUA IMPLANT RECONSTRUCTIVE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 F TAGGART DR
NASHUA NH
03060
US

IV. Provider business mailing address

7 F TAGGART DR
NASHUA NH
03060
US

V. Phone/Fax

Practice location:
  • Phone: 603-888-8100
  • Fax: 603-888-7200
Mailing address:
  • Phone: 603-888-8100
  • Fax: 603-888-7200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number3204
License Number StateNH

VIII. Authorized Official

Name: DR. ASHOK K PATEL
Title or Position: PRESIDENT AND OWNER
Credential: MDS, DMD
Phone: 603-888-8100