| NPI | 1639385289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI L BERGERON Practice Manager 603-643-4142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NH 2648) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2020-08-22 |