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General NPI Number Information
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NPI Number | 1275884132
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Entity Type | Organization
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Legal Business Name | BRENTWOOD DENTAL DESIGNS, PLLC
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 1 BRICKYARD SQ SUITE 5
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City | EPPING
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State | NH
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Zip | 03042-4402
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Country | US
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Telephone | 603-679-3679
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Fax | 603-679-3779
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Provider Business Mailing Address
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Address Line | 1 BRICKYARD SQ SUITE 5
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City | EPPING
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State | NH
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Zip | 03042-4402
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Country | US
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Telephone | 603-679-3679
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Fax | 603-679-3779
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. TAMATHA L JOHNSON
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Credential | DDS
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Telephone | 603-679-3679
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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 | 03591
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License Number State | NH
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