Healthcare Provider Details

I. General information

NPI: 1366151102
Provider Name (Legal Business Name): PLAISTOW PEDIATRIC DENTISTRY & ORTHODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 02/08/2023
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 PLAISTOW RD
PLAISTOW NH
03865-2843
US

IV. Provider business mailing address

166 PLAISTOW RD
PLAISTOW NH
03865-2843
US

V. Phone/Fax

Practice location:
  • Phone: 603-974-1150
  • Fax:
Mailing address:
  • Phone: 603-974-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MEG HORAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 603-974-1150