=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326448812
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAMPREY HEALTH CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2014
-----------------------------------------------------
Last Update Date | 03/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 128 ROUTE 27
-----------------------------------------------------
City | RAYMOND
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03077-1220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-895-3351
-----------------------------------------------------
Fax | 603-895-8003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 128 ROUTE 27
-----------------------------------------------------
City | RAYMOND
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03077-1220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-895-3351
-----------------------------------------------------
Fax | 603-895-8003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | GREGORY WHITE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 603-659-2494
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------