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General NPI Number Information
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NPI Number | 1609159490
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Entity Type | Organization
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Legal Business Name | MONADNOCK DENTAL SLEEP THERAPY PLLC
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Dates
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Enumeration Date | 09/28/2011
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Last Update Date | 09/28/2011
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Provider Practice Location Address
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Address Line | 650 COURT ST SUITE #2
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City | KEENE
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State | NH
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Zip | 03431-1758
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Country | US
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Telephone | 603-357-0230
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Fax |
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Provider Business Mailing Address
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Address Line | 650 COURT ST SUITE #2
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City | KEENE
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State | NH
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Zip | 03431-1758
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Country | US
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Telephone | 603-357-0230
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SEAN P DROWER
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Credential | DMD
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Telephone | 603-357-0230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 3163
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License Number State | NH
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