Provider Demographics
NPI:1003834045
Name:AUBURN FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:AUBURN FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLDUC
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-483-8123
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NH
Mailing Address - Zip Code:03032-0425
Mailing Address - Country:US
Mailing Address - Phone:603-483-8123
Mailing Address - Fax:603-483-8127
Practice Address - Street 1:7 RAYMOND RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NH
Practice Address - Zip Code:03032-0425
Practice Address - Country:US
Practice Address - Phone:603-483-8123
Practice Address - Fax:603-483-8127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH18701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30313402Medicaid
NH30306440Medicaid
NH81192076Medicaid
NH30319916Medicaid