Provider Demographics
NPI:1104017128
Name:DAVID IENI DDS, PLLC
Entity Type:Organization
Organization Name:DAVID IENI DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:IENI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-356-6505
Mailing Address - Street 1:2759 WHITE MOUNTAIN HWY
Mailing Address - Street 2:P.O. BOX 448
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-5123
Mailing Address - Country:US
Mailing Address - Phone:603-356-6505
Mailing Address - Fax:603-356-2758
Practice Address - Street 1:2759 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5123
Practice Address - Country:US
Practice Address - Phone:603-356-6505
Practice Address - Fax:603-356-2758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03586122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty