Healthcare Provider Details

I. General information

NPI: 1437166584
Provider Name (Legal Business Name): WHITE MOUNTAIN ORAL & MAXILLOFACIAL SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3277 WHITE MOUNTAIN HWY
NORTH CONWAY NH
03860-5113
US

IV. Provider business mailing address

PO BOX 1289
NORTH CONWAY NH
03860-1289
US

V. Phone/Fax

Practice location:
  • Phone: 603-356-9755
  • Fax: 603-356-9754
Mailing address:
  • Phone: 603-356-9755
  • Fax: 603-356-9754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DREW G SMITH
Title or Position: OWNER/PRESIDENT
Credential: DDS
Phone: 603-356-9755