=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922329036
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PORTSMOUTH DENTAL STUDIOS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2010
-----------------------------------------------------
Last Update Date | 08/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 EILEEN DONDERO FOLEY AVE SUITE 320
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-431-7605
-----------------------------------------------------
Fax | 603-433-5381
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 EILEEN DONDERO FOLEY AVE SUITE 320
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-431-7605
-----------------------------------------------------
Fax | 603-433-5381
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | BRIAN MICHAEL HUNTER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 603-431-7605
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 3309
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 1166
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 3739
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------