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General NPI Number Information
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NPI Number | 1740499052
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Entity Type | Individual
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Provider Name | STEPHEN ROBERT BOONE DDS
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 85 SPRING ST STE 301
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City | LACONIA
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State | NH
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Zip | 03246-3113
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Country | US
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Telephone | 603-524-8211
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Fax | 603-524-3986
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Provider Business Mailing Address
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Address Line | 85 SPRING ST STE 301
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City | LACONIA
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State | NH
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Zip | 03246-3113
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Country | US
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Telephone | 603-524-8211
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Fax | 603-524-3986
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 050446
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 03967
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License Number State | NH
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