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General NPI Number Information
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NPI Number | 1558539098
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Entity Type | Organization
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Legal Business Name | FREESE & BENGTSON FAMILY DENTISTRY, PLLC
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 07/02/2013
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Provider Practice Location Address
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Address Line | 16 WALL ST
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City | CONCORD
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State | NH
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Zip | 03301-3743
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Country | US
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Telephone | 603-228-3384
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Fax | 603-228-3366
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Provider Business Mailing Address
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Address Line | 16 WALL STREET
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City | CONCORD
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State | NH
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Zip | 03301
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Country | US
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Telephone | 603-228-3384
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Fax | 603-228-3366
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN R BENGTSON
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Credential | DMD
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Telephone | 603-228-3384
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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 | 2099
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License Number State | NH
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