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General NPI Number Information
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NPI Number | 1164961611
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Entity Type | Organization
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Legal Business Name | SEACOAST CHILDREN'S DENTISTRY
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Dates
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Enumeration Date | 02/16/2017
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Last Update Date | 02/16/2017
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Provider Practice Location Address
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Address Line | 13 MARCH FARM WAY UNIT A
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City | GREENLAND
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State | NH
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Zip | 03840
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Country | US
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Telephone | 603-319-4101
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Fax |
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Provider Business Mailing Address
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Address Line | 13 MARCH FARM WAY UNIT A
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City | GREENLAND
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State | NH
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Zip | 03840
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Country | US
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Telephone | 603-319-4101
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. ADAM JOASH BOTTRILL
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Credential | D.M.D.
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Telephone | 603-319-4101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 03849
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License Number State | NH
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