1649974072 NPI number — PREMIER CARE DENTISTRY OF NEW HAMPSHIRE

Table of content: TAYLOR NICOLE THOMAS LMSW (NPI 1841091501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649974072 NPI number — PREMIER CARE DENTISTRY OF NEW HAMPSHIRE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER CARE DENTISTRY OF NEW HAMPSHIRE
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:
1649974072
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 MAXESS RD STE 107N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11747-3859
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 CONTINENTAL BLVD STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRIMACK
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03054-4339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-769-4327
Provider Business Practice Location Address Fax Number:
631-396-0452
Provider Enumeration Date:
03/29/2023

Additional Information

Authorized Official

Authorized Official Last Name:
SORIANO
Authorized Official First Name:
HIRO
Authorized Official Middle Name:
Authorized Official Title or Position:
CIO
Authorized Official Telephone Number:
516-344-5746

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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