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General NPI Number Information
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NPI Number | 1932509148
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Entity Type | Organization
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Legal Business Name | GREAT BAY DENTAL CARE
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Dates
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Enumeration Date | 08/26/2014
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Last Update Date | 08/26/2014
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Provider Practice Location Address
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Address Line | 48 N MAIN ST
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City | NEWMARKET
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State | NH
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Zip | 03857-1210
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Country | US
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Telephone | 603-659-3341
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Fax | 603-659-4418
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Provider Business Mailing Address
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Address Line | 48 N MAIN ST
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City | NEWMARKET
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State | NH
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Zip | 03857-1210
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Country | US
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Telephone | 603-659-3341
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Fax | 603-659-4418
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY J GOSLEE
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Credential | DMD
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Telephone | 603-659-3341
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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 | 03681
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License Number State | NH
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