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General NPI Number Information
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NPI Number | 1497166367
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Entity Type | Organization
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Legal Business Name | SEABROOK DENTAL CARE CORP
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 05/14/2014
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Provider Practice Location Address
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Address Line | 12 STILES RD SUITE 205
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City | SALEM
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State | NH
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Zip | 03079-2879
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Country | US
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Telephone | 603-898-9180
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Fax |
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Provider Business Mailing Address
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Address Line | 12 STILES RD STE 205
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City | SALEM
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State | NH
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Zip | 03079-2881
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Country | US
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Telephone | 603-898-9180
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Fax | 603-389-9257
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Authorized Official
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Title or Position | DENTIST
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Name | DR. RIDHIMA GOYAL
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Credential | D.M.D
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Telephone | 603-898-9180
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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 | 04014
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 03434
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 03726
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License Number State | NH
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