Healthcare Provider Details

I. General information

NPI: 1013431097
Provider Name (Legal Business Name): PLYMOUTH DENTISTRY & IMPLANTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MAIN ST
PLYMOUTH NH
03264-1439
US

IV. Provider business mailing address

2 MAIN ST
PLYMOUTH NH
03264-1439
US

V. Phone/Fax

Practice location:
  • Phone: 603-536-1445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ANGELINA BLANKSCHEN
Title or Position: ADMINSITRATOR
Credential:
Phone: 860-997-0569