Healthcare Provider Details

I. General information

NPI: 1124340781
Provider Name (Legal Business Name): MARTIN RICHARD EVVARD D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 WAKEFIELD ST
ROCHESTER NH
03867-1958
US

IV. Provider business mailing address

18 WAKEFIELD ST
ROCHESTER NH
03867-1958
US

V. Phone/Fax

Practice location:
  • Phone: 603-332-1796
  • Fax: 603-332-1796
Mailing address:
  • Phone: 603-332-1796
  • Fax: 603-332-1796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1642
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: