Provider Demographics
NPI:1033121090
Name:PAUL L JANE DDS, DAVID A HEDSTROM DDS, JASPER AINSLIE DDS, PA
Entity Type:Organization
Organization Name:PAUL L JANE DDS, DAVID A HEDSTROM DDS, JASPER AINSLIE DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:JANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-924-3664
Mailing Address - Street 1:21 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1424
Mailing Address - Country:US
Mailing Address - Phone:603-924-3664
Mailing Address - Fax:
Practice Address - Street 1:21 GROVE ST
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1424
Practice Address - Country:US
Practice Address - Phone:603-924-3664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99001669Medicaid