Provider Demographics
NPI:1053656363
Name:DAVID IENI DDS FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:DAVID IENI DDS FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:IENI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-742-2164
Mailing Address - Street 1:38 NELSON ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3736
Mailing Address - Country:US
Mailing Address - Phone:603-742-2164
Mailing Address - Fax:
Practice Address - Street 1:38 NELSON ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3736
Practice Address - Country:US
Practice Address - Phone:603-742-2164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03586122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty