1255671178 NPI number — SEASIDE SMILES, PLLC

Table of content: (NPI 1255671178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255671178 NPI number — SEASIDE SMILES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEASIDE SMILES, 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:
6
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:
1255671178
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1498
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03809-1498
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-280-4500
Provider Business Mailing Address Fax Number:
603-632-3620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
82 MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03809-1498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-280-4500
Provider Business Practice Location Address Fax Number:
603-632-3620
Provider Enumeration Date:
03/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
603-280-4500

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  DN17086 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3108842 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com