Provider Demographics
NPI:1073731733
Name:SEACOAST ENDODONTIC ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:SEACOAST ENDODONTIC ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-742-2200
Mailing Address - Street 1:113 NEW ROCHESTER RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-8800
Mailing Address - Country:US
Mailing Address - Phone:603-742-2200
Mailing Address - Fax:603-742-1105
Practice Address - Street 1:113 NEW ROCHESTER RD
Practice Address - Street 2:SUITE 3
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-8800
Practice Address - Country:US
Practice Address - Phone:603-742-2200
Practice Address - Fax:603-742-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13661223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty