Provider Demographics
NPI:1063024487
Name:EXETER DENTAL IMPLANT AND ORAL SURGERY CENTER
Entity Type:Organization
Organization Name:EXETER DENTAL IMPLANT AND ORAL SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAILEY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GROLEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-527-8057
Mailing Address - Street 1:21 HAMPTON RD STE 202
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-4800
Mailing Address - Country:US
Mailing Address - Phone:603-773-3333
Mailing Address - Fax:603-718-3096
Practice Address - Street 1:21 HAMPTON RD STE 202
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4800
Practice Address - Country:US
Practice Address - Phone:603-773-3333
Practice Address - Fax:603-718-3096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty