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General NPI Number Information
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NPI Number | 1780094763
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Entity Type | Organization
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Legal Business Name | DOVER PEDIATRIC DENTISTRY & ORTHODONTICS PLLC
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Dates
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Enumeration Date | 04/30/2014
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 750 CENTRAL AVE SUITE K
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City | DOVER
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State | NH
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Zip | 03820-3434
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Country | US
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Telephone | 603-743-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 750 CENTRAL AVE SUITE K
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City | DOVER
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State | NH
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Zip | 03820-3434
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Country | US
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Telephone | 603-743-6000
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Fax |
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Authorized Official
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Title or Position | DOCTOR / DENTIST
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Name | DR. GARY DON WENDELL
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Credential | D.D.S.
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Telephone | 603-686-3928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 3134
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License Number State | NH
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