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General NPI Number Information
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NPI Number | 1831211614
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Entity Type | Organization
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Legal Business Name | KEYSTONE DENTAL ARTS
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 263 ROUTE 108
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City | SOMERSWORTH
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State | NH
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Zip | 03878-1512
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Country | US
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Telephone | 603-692-9229
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Fax |
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Provider Business Mailing Address
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Address Line | 263 ROUTE 108
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City | SOMERSWORTH
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State | NH
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Zip | 03878-1512
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Country | US
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Telephone | 603-692-9229
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | VICTORIA A INGERSOLL
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Credential |
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Telephone | 603-692-9229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1427
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License Number State | NH
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