Healthcare Provider Details

I. General information

NPI: 1104430131
Provider Name (Legal Business Name): PLAISTOW DENTAL IMPLANT AND ORAL SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 PLAISTOW RD UNIT 3
PLAISTOW NH
03865-2843
US

IV. Provider business mailing address

166 PLAISTOW RD UNIT 3
PLAISTOW NH
03865-2843
US

V. Phone/Fax

Practice location:
  • Phone: 603-257-7080
  • Fax: 603-257-7080
Mailing address:
  • Phone: 603-257-7080
  • Fax: 603-257-7080

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: MR. KYLE STIEFEL
Title or Position: OWNER/DOCTOR
Credential: DDS
Phone: 603-257-7080