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General NPI Number Information
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NPI Number | 1326540253
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Entity Type | Organization
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Legal Business Name | ONE COMMONS ENDODONTICS PLLC
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 03/07/2018
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Provider Practice Location Address
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Address Line | 1F COMMONS DR UNIT 39
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City | LONDONDERRY
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State | NH
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Zip | 03053-3474
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Country | US
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Telephone | 603-552-3632
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Fax | 603-818-4903
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Provider Business Mailing Address
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Address Line | 1F COMMONS DR UNIT 39
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City | LONDONDERRY
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State | NH
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Zip | 03053-3474
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Country | US
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Telephone | 603-552-3632
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Fax | 603-818-4903
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER S MIRUCKI
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Credential | DMD
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Telephone | 603-552-3632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 03977
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License Number State | NH
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