1538259221 NPI number — PARKWAY DENTAL ASSOCIATES

Table of content: (NPI 1538259221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538259221 NPI number — PARKWAY DENTAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARKWAY DENTAL ASSOCIATES
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:
1538259221
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 CHESTNUT ST STE 2
Provider Second Line Business Mailing Address:
BELKNAP DENTAL ASSOCIATION
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03820-3335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-742-4735
Provider Business Mailing Address Fax Number:
603-742-9911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 CHESTNUT ST STE 2
Provider Second Line Business Practice Location Address:
BELKNAP DENTAL ASSOCIATION
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03820-3335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-742-4735
Provider Business Practice Location Address Fax Number:
603-742-9911
Provider Enumeration Date:
10/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHAIKIN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
603-742-4735

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  1245 , 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: 30011191 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139160000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111194 . This is a "AETNA DMU" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 128085 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".