Healthcare Provider Details

I. General information

NPI: 1730226382
Provider Name (Legal Business Name): EDGAR T HASTINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MONADNOCK HWY
SWANZEY NH
03446-2114
US

IV. Provider business mailing address

116 MONADNOCK HIGHWAY
SWANZEY NH
03446
US

V. Phone/Fax

Practice location:
  • Phone: 603-357-7707
  • Fax: 603-352-5628
Mailing address:
  • Phone: 603-357-7707
  • Fax: 603-352-5628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2422
License Number StateNH

VIII. Authorized Official

Name: EDGAR T HASTINGS
Title or Position: OWNER
Credential:
Phone: 603-357-7707