Healthcare Provider Details

I. General information

NPI: 1336676493
Provider Name (Legal Business Name): YOUR NASHUA DENTIST, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 07/21/2022
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CONCORD ST
NASHUA NH
03064-2355
US

IV. Provider business mailing address

6 CONCORD ST
NASHUA NH
03064-2355
US

V. Phone/Fax

Practice location:
  • Phone: 603-882-8000
  • Fax: 603-676-7066
Mailing address:
  • Phone: 603-882-8000
  • Fax: 603-676-7066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number04295
License Number StateNH

VIII. Authorized Official

Name: JUN YU
Title or Position: DENTIST
Credential:
Phone: 603-882-8000