=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154515633
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEWPORT DENTAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2007
-----------------------------------------------------
Last Update Date | 08/28/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 COITVIEW DR
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03773-1481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-863-1871
-----------------------------------------------------
Fax | 603-863-6550
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 COITVIEW DR
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03773-1481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-863-1871
-----------------------------------------------------
Fax | 603-863-6550
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. FRANK QUAARTIELLO
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 603-863-1871
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 1183
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------