MEDICARE: JENNIE P CARCAUD-HENNIGAR DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223D0001X	Public Health Dentistry	03311	NH

General Provider Information

NPI Number	:	1093959595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIE P CARCAUD-HENNIGAR DMD

Provider Business Mailing Address
First Line	:	448 WHITE MOUNTAIN HWY
Second Line	:	DENTAL CENTER
City	:	TAMWORTH
State	:	NH
Zip	:	03886-4626
Country	:	US
Telephone Number	:	603-323-7645
Fax Number	:	603-323-7647

Provider Business Practice Location Address
First Line	:	448 WHITE MOUNTAIN HWY
Second Line	:	DENTAL CENTER
City	:	TAMWORTH
State	:	NH
Zip	:	03886-4626
Country	:	US
Telephone Number	:	603-323-7645
Fax Number	:	603-323-7647

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2009
Last Update Date	:	04/28/2009

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