=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215050174
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONALD MARK DUMAIS DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 155 DOW ST SUITE 401
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03101-1299
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-622-6073
-----------------------------------------------------
Fax | 603-622-8350
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 CARDINAL DR
-----------------------------------------------------
City | BOW
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03304-5708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-715-5208
-----------------------------------------------------
Fax | 603-622-6073
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 2287
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------