=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134257447
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOUGLAS E DUVAL, DDS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1142 SOMERVILLE ST
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03103-2847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-622-9225
-----------------------------------------------------
Fax | 603-624-1695
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 FOXCROSS CIR
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03301-6920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-226-4649
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DOUGLAS E DUVAL
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 603-622-9225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 2041
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------