Provider Demographics
NPI:1033529375
Name:CHILDREN'S DENTISTRY OF COCHECO VALLEY, LLP
Entity Type:Organization
Organization Name:CHILDREN'S DENTISTRY OF COCHECO VALLEY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:LUCIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-617-2882
Mailing Address - Street 1:750 CENTRAL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3434
Mailing Address - Country:US
Mailing Address - Phone:603-617-2882
Mailing Address - Fax:603-617-2809
Practice Address - Street 1:750 CENTRAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3434
Practice Address - Country:US
Practice Address - Phone:603-617-2882
Practice Address - Fax:603-617-2809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty