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General NPI Number Information
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NPI Number | 1417168030
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Entity Type | Individual
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Provider Name | GIRARD THOMAS NISTA DDS
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Gender | Male
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 89 PORTSMOUTH AVE
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City | STRATHAM
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State | NH
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Zip | 03885-2467
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Country | US
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Telephone | 603-778-8181
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Fax | 603-772-4942
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Provider Business Mailing Address
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Address Line | 89 PORTSMOUTH AVE
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City | STRATHAM
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State | NH
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Zip | 03885-2467
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Country | US
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Telephone | 603-778-8181
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Fax | 603-772-4942
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1030
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License Number State | NH
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