=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598979379
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RODNEY G. SIGUA, DDS, FAGD, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25 HALL ST SUITE 301
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03301-3471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-223-6644
-----------------------------------------------------
Fax | 603-224-1712
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 HALL ST SUITE 301
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03301-3471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-223-6644
-----------------------------------------------------
Fax | 603-224-1712
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RODNEY GEORGE SIGUA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 603-223-6644
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 2606
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------