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General NPI Number Information
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NPI Number | 1770782906
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Entity Type | Organization
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Legal Business Name | JEAN R CHAGNON, DDS PA
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 206 RIVERWAY PL
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City | BEDFORD
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State | NH
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Zip | 03110-6763
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Country | US
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Telephone | 603-625-9606
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Fax | 603-634-5135
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Provider Business Mailing Address
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Address Line | 206 RIVERWAY PL
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City | BEDFORD
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State | NH
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Zip | 03110-6763
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Country | US
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Telephone | 603-625-9606
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Fax | 603-634-5135
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEAN R CHAGNON
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Credential | DDS
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Telephone | 603-625-9606
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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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