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General NPI Number Information
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NPI Number | 1861890410
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Entity Type | Organization
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Legal Business Name | ULYIMATE DENTAL CARE LLC
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Dates
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Enumeration Date | 12/15/2014
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Last Update Date | 12/15/2014
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Provider Practice Location Address
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Address Line | 410 S MAIN ST
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City | CONCORD
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State | NH
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Zip | 03301-3483
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Country | US
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Telephone | 603-224-1851
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Fax | 603-224-7240
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Provider Business Mailing Address
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Address Line | 410 S MAIN ST
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City | CONCORD
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State | NH
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Zip | 03301-3483
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Country | US
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Telephone | 603-224-1851
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Fax | 603-224-7240
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Authorized Official
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Title or Position | MANAGER
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Name | DR. MOSTAFA H. EL-SHERIF
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Credential | DMD,MSCD,PHD
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Telephone | 603-731-0100
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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 |
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License Number State |
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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 |
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License Number State |
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