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General NPI Number Information
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NPI Number | 1457593766
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Entity Type | Organization
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Legal Business Name | MERRIMACK VALLEY DENTAL CLINIC PC
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 1794 BRIDGE ST STE 22A
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City | DRACUT
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State | MA
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Zip | 01826-2680
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Country | US
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Telephone | 978-454-8221
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Fax | 978-446-0911
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Provider Business Mailing Address
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Address Line | 1794 BRIDGE ST STE 22A
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City | DRACUT
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State | MA
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Zip | 01826-2680
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Country | US
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Telephone | 978-454-8221
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Fax | 978-446-0911
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER NIARHOS
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Credential | DMD
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Telephone | 978-454-8221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17303
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License Number State | MA
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