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General NPI Number Information
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NPI Number | 1477754810
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Entity Type | Organization
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Legal Business Name | MONADNOCK ORAL AND MAXILLOFACIAL SURGERY, PC
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 272 MAIN ST
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City | KEENE
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State | NH
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Zip | 03431-4144
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Country | US
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Telephone | 603-357-3709
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Fax | 603-352-5722
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Provider Business Mailing Address
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Address Line | 165 S LINCOLN ST
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City | KEENE
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State | NH
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Zip | 03431-3830
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Country | US
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Telephone | 603-355-1371
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LEONARD L WELDON
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Credential | DDS
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Telephone | 603-357-3709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 3047
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License Number State | NH
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