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General NPI Number Information
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NPI Number | 1497979918
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Entity Type | Organization
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Legal Business Name | LIFETIME DENTAL PROFESSIONALS OF NEW HAMPSHIRE, P.C.
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 107 MAIN STREET
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City | PLYMOUTH
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State | NH
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Zip | 03264
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Country | US
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Telephone | 603-536-4009
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Fax | 603-536-1033
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Provider Business Mailing Address
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Address Line | 107 MAIN STREET
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City | PLYMOUTH
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State | NH
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Zip | 03264
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Country | US
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Telephone | 603-536-4009
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Fax | 603-536-1033
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | LORI EDMONDS
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Credential |
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Telephone | 217-540-8468
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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 |
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License Number State |
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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 |
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License Number State | NH
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