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General NPI Number Information
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NPI Number | 1144272352
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Entity Type | Organization
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Legal Business Name | CONCORD ORAL SURGERY PROFESSIONAL ASSOCIATION
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 194 PLEASANT ST SUITE 13
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City | CONCORD
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State | NH
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Zip | 03301-2952
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Country | US
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Telephone | 603-225-3482
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Fax | 603-224-2331
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Provider Business Mailing Address
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Address Line | 194 PLEASANT ST SUITE 13
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City | CONCORD
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State | NH
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Zip | 03301-2952
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Country | US
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Telephone | 603-225-3482
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Fax | 603-224-2331
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK M. SCURA
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Credential | D.M.D.
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Telephone | 603-225-3482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2186
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License Number State | NH
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