Healthcare Provider Details

I. General information

NPI: 1093959595
Provider Name (Legal Business Name): JENNIE P CARCAUD-HENNIGAR DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 WHITE MOUNTAIN HWY DENTAL CENTER
TAMWORTH NH
03886-4626
US

IV. Provider business mailing address

448 WHITE MOUNTAIN HWY DENTAL CENTER
TAMWORTH NH
03886-4626
US

V. Phone/Fax

Practice location:
  • Phone: 603-323-7645
  • Fax: 603-323-7647
Mailing address:
  • Phone: 603-323-7645
  • Fax: 603-323-7647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number03311
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: