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General NPI Number Information
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NPI Number | 1033393624
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Entity Type | Organization
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Legal Business Name | MARQUE MANAGEMENT LLC
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 373 S WILLOW ST SUITE D1-6
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City | MANCHESTER
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State | NH
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Zip | 03103-5751
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Country | US
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Telephone | 603-622-6288
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Fax |
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Provider Business Mailing Address
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Address Line | 373 S WILLOW ST SUITE D1-6
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City | MANCHESTER
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State | NH
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Zip | 03103-5751
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Country | US
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Telephone | 603-622-6288
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SHANNON M FARRELL
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Credential | D.M.D.
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Telephone | 603-622-6288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3568
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License Number State | NH
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