=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053678789
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAVING PEOPLE'S SMILE DENTAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2012
-----------------------------------------------------
Last Update Date | 04/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 194 PLEASANT ST SUITE 6
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03301-2952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-219-0770
-----------------------------------------------------
Fax | 603-219-0337
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 194 PLEASANT ST SUITE 6
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03301-2952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-219-0770
-----------------------------------------------------
Fax | 603-219-0337
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | EARLE WYATT SIMPSON JR.
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 603-219-0770
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------