1578681417 NPI number — ALLIANCE FOR DENTAL CARE, PLLC

Table of content: (NPI 1578681417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578681417 NPI number — ALLIANCE FOR DENTAL CARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIANCE FOR DENTAL CARE, 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:
1578681417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 WINTER ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03867-3153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-332-7300
Provider Business Mailing Address Fax Number:
603-332-7331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 WINTER ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03867-3153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-332-7300
Provider Business Practice Location Address Fax Number:
603-332-7331
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOODSPEED
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
LAURION
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
603-332-7300

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  1946 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 3370 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 927 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 03538 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 50Y141600NH01 . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 898915 . This is a "UNITED CONCORDIA GROUP #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30313822 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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