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General NPI Number Information
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NPI Number | 1013431097
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Entity Type | Organization
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Legal Business Name | PLYMOUTH DENTISTRY & IMPLANTS, PLLC
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 12/06/2017
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Provider Practice Location Address
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Address Line | 2 MAIN ST
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City | PLYMOUTH
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State | NH
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Zip | 03264-1439
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Country | US
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Telephone | 603-536-1445
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Fax |
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Provider Business Mailing Address
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Address Line | 2 MAIN ST
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City | PLYMOUTH
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State | NH
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Zip | 03264-1439
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINSITRATOR
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Name | ANGELINA BLANKSCHEN
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Credential |
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Telephone | 860-997-0569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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