Provider Demographics
NPI:1003126616
Name:DENTAL SLEEP THERAPY CENTER OF NH
Entity Type:Organization
Organization Name:DENTAL SLEEP THERAPY CENTER OF NH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:GRAVEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-472-3255
Mailing Address - Street 1:56 JOHN GOFFE DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6110
Mailing Address - Country:US
Mailing Address - Phone:603-472-3255
Mailing Address - Fax:603-472-7072
Practice Address - Street 1:56 JOHN GOFFE DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6110
Practice Address - Country:US
Practice Address - Phone:603-472-3255
Practice Address - Fax:603-472-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1198261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental