Healthcare Provider Details

I. General information

NPI: 1902862931
Provider Name (Legal Business Name): DEBRA FILOCOMA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 GRIFFIN RD SUITE 2
PORTSMOUTH NH
03801-7131
US

IV. Provider business mailing address

4 TOBEY LN
ANDOVER MA
01810-5710
US

V. Phone/Fax

Practice location:
  • Phone: 603-436-2204
  • Fax: 603-436-4158
Mailing address:
  • Phone: 978-470-3417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2612
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: