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General NPI Number Information
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NPI Number | 1033529375
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Entity Type | Organization
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Legal Business Name | CHILDREN'S DENTISTRY OF COCHECO VALLEY, LLP
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Dates
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Enumeration Date | 05/07/2014
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Last Update Date | 05/07/2014
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Provider Practice Location Address
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Address Line | 750 CENTRAL AVE SUITE B
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City | DOVER
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State | NH
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Zip | 03820-3434
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Country | US
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Telephone | 603-617-2882
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Fax | 603-617-2809
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Provider Business Mailing Address
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Address Line | 750 CENTRAL AVE SUITE B
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City | DOVER
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State | NH
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Zip | 03820-3434
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Country | US
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Telephone | 603-617-2882
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Fax | 603-617-2809
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | MARK S LUCIER
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Credential |
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Telephone | 603-617-2882
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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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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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