=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154525624
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NHOMS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2007
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 TRAFALGAR SQ SUITE 201
-----------------------------------------------------
City | NASHUA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03063-4900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-595-8889
-----------------------------------------------------
Fax | 603-595-2027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 TRAFALGAR SQ SUITE 201
-----------------------------------------------------
City | NASHUA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03063-4900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-595-8889
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. NADER MOAVENIAN
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 603-595-8889
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
-----------------------------------------------------
License Number | 3216
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------