1316151798 NPI number — CAPITOL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, PLLC

Table of content: (NPI 1316151798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316151798 NPI number — CAPITOL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITOL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316151798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 LOUDON RD
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03301-5321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-225-0008
Provider Business Mailing Address Fax Number:
603-225-8120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 WILTON RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PETERBOROUGH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03458-1749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-784-5447
Provider Business Practice Location Address Fax Number:
603-784-5449
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROSATO
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
603-225-0008

Provider Taxonomy Codes

  • Taxonomy code: 204E00000X , with the licence number:  3188 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02Y002478NH02 . This is a "ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30314308 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2027588 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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