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General NPI Number Information
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NPI Number | 1346645884
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Entity Type | Organization
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Legal Business Name | EMILY JEANNE SAMUEL
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Dates
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Enumeration Date | 10/27/2014
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 24 WESTMINSTER STREET WEST
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City | WALPOLE
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State | NH
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Zip | 03608-0815
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Country | US
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Telephone | 603-904-4150
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 815 24 WESTMINSTER STREET
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City | WALPOLE
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State | NH
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Zip | 03608-0815
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Country | US
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Telephone | 603-904-4150
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR/DOCTOR
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Name | DR. EMILY JEANNE SAMUEL
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Credential | DMD
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Telephone | 603-904-4150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 03146
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License Number State | NH
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