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General NPI Number Information
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NPI Number | 1467949123
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Entity Type | Organization
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Legal Business Name | EBRIGHT & SMART FAMILY DENTISTRY
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 04/18/2018
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Provider Practice Location Address
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Address Line | 77 GILCREAST RD STE 1004
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City | LONDONDERRY
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State | NH
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Zip | 03053-3518
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Country | US
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Telephone | 603-434-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 77 GILCREAST RD STE 1004
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City | LONDONDERRY
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State | NH
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Zip | 03053-3518
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Country | US
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Telephone | 603-434-8800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TREVOR DOUGLAS SMART
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Credential | DMD
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Telephone | 603-434-8800
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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 | 04063
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License Number State | NH
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