1629303086 NPI number — DENTAL ARTS OF BEDFORD

Table of content: (NPI 1629303086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629303086 NPI number — DENTAL ARTS OF BEDFORD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL ARTS OF BEDFORD
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:
1629303086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 S RIVER RD
Provider Second Line Business Mailing Address:
BEDFORD PLACE UNIT #33
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03110-6719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-647-2278
Provider Business Mailing Address Fax Number:
603-622-1616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 S RIVER RD
Provider Second Line Business Practice Location Address:
BEDFORD PLACE UNIT #33
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03110-6719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-647-2278
Provider Business Practice Location Address Fax Number:
603-622-1616
Provider Enumeration Date:
10/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ROLKE
Authorized Official First Name:
LORI
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
603-647-2278

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  3535 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 3118 , 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: 30314423 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com