Healthcare Provider Details

I. General information

NPI: 1578681417
Provider Name (Legal Business Name): ALLIANCE FOR DENTAL CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WINTER ST SUITE 201
ROCHESTER NH
03867-3153
US

IV. Provider business mailing address

40 WINTER ST SUITE 201
ROCHESTER NH
03867-3153
US

V. Phone/Fax

Practice location:
  • Phone: 603-332-7300
  • Fax: 603-332-7331
Mailing address:
  • Phone: 603-332-7300
  • Fax: 603-332-7331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3370
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number927
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number03538
License Number StateNH
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1946
License Number StateNH

VIII. Authorized Official

Name: DR. RENEE LAURION GOODSPEED
Title or Position: OWNER
Credential: D.D.S.
Phone: 603-332-7300