=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922138064
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R. SUSAN HORSLEY, D.M.D
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 322 AMHERST ST
-----------------------------------------------------
City | NASHUA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03063-1720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-881-8844
-----------------------------------------------------
Fax | 603-886-6513
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 322 AMHERST ST
-----------------------------------------------------
City | NASHUA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03063-1720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-881-8844
-----------------------------------------------------
Fax | 603-886-6513
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ENDODONTIST
-----------------------------------------------------
Name | ROCHELLE SUSAN HORSLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 603-881-8844
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | 2510
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------