Healthcare Provider Details

I. General information

NPI: 1710370531
Provider Name (Legal Business Name): SANDRA MROZ-MARONI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 EXETER RD
NEWMARKET NH
03857-1940
US

IV. Provider business mailing address

164 GREAT BAY RD
GREENLAND NH
03840-2132
US

V. Phone/Fax

Practice location:
  • Phone: 603-659-3392
  • Fax:
Mailing address:
  • Phone: 603-427-2536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: