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General NPI Number Information
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NPI Number | 1356693642
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Entity Type | Organization
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Legal Business Name | SMILE MASTER OF CONCORD
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Dates
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Enumeration Date | 10/10/2012
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Last Update Date | 10/10/2012
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Provider Practice Location Address
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Address Line | 246 PLEASANT ST # 225A
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City | CONCORD
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State | NH
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Zip | 03301-2548
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Country | US
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Telephone | 603-856-8767
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Fax | 603-856-8026
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Provider Business Mailing Address
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Address Line | 246 PLEASANT ST # 225A
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City | CONCORD
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State | NH
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Zip | 03301-2548
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Country | US
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Telephone | 603-856-8767
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Fax | 603-856-8026
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOSTAFA H EL-SHERIF
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Credential | DMD,MSCD,PHD
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Telephone | 603-856-8767
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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 | 2650
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License Number State | NH
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