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General NPI Number Information
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NPI Number | 1336676493
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Entity Type | Organization
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Legal Business Name | YOUR NASHUA DENTIST, PLLC
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Dates
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Enumeration Date | 05/18/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6 CONCORD ST
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City | NASHUA
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State | NH
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Zip | 03064-2355
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Country | US
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Telephone | 603-882-8000
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Fax | 603-676-7066
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Provider Business Mailing Address
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Address Line | 6 CONCORD ST
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City | NASHUA
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State | NH
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Zip | 03064-2355
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Country | US
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Telephone | 603-882-8000
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Fax | 603-676-7066
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Authorized Official
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Title or Position | DENTIST
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Name | JUN YU
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Credential |
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Telephone | 603-882-8000
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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 | 04295
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License Number State | NH
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