Healthcare Provider Details

I. General information

NPI: 1093353526
Provider Name (Legal Business Name): NADER MOAVENIAN, DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SHEEP DAVIS RD
PEMBROKE NH
03275-3702
US

IV. Provider business mailing address

33 TRAFALGAR SQ STE 201
NASHUA NH
03063-4901
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-7831
  • Fax: 603-224-8549
Mailing address:
  • Phone: 603-595-8889
  • Fax: 603-595-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: JO GOY
Title or Position: BILLING COORDINATOR
Credential:
Phone: 603-595-8889