Healthcare Provider Details

I. General information

NPI: 1790960177
Provider Name (Legal Business Name): BAY BREEZE DENTISTRY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MANCHESTER SQ STE 215
PORTSMOUTH NH
03801-8003
US

IV. Provider business mailing address

14 MANCHESTER SQ STE 215
PORTSMOUTH NH
03801-8003
US

V. Phone/Fax

Practice location:
  • Phone: 603-610-8765
  • Fax: 603-610-8766
Mailing address:
  • Phone: 603-610-8765
  • Fax: 603-610-8766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number3451
License Number StateNH

VIII. Authorized Official

Name: DR. CARMEN VIRGINIA SANTANA-PAINE
Title or Position: DENTIST/OWNER
Credential: D.M.D
Phone: 603-610-8765