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General NPI Number Information
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NPI Number | 1528480902
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Entity Type | Organization
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Legal Business Name | CONWAY VILLAGE DENTAL
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Dates
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Enumeration Date | 01/20/2014
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 21A POLIQUIN DRIVE
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City | CONWAY
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State | NH
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Zip | 03818
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Country | US
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Telephone | 603-447-6707
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Fax | 603-447-8376
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Provider Business Mailing Address
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Address Line | 21A POLIQUIN DRIVE
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City | CONWAY
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State | NH
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Zip | 03818
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Country | US
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Telephone | 603-447-6707
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Fax | 603-447-8376
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Authorized Official
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Title or Position | CEO
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Name | DR. JULIE ANN DUDEVOIR-BADGER
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Credential | DDS
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Telephone | 603-447-6707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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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 |
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