Provider Demographics
NPI:1124552104
Name:HILLSIDE FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:HILLSIDE FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAKULA MORIARTY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-483-2176
Mailing Address - Street 1:410 RAYMOND ROAD
Mailing Address - Street 2:
Mailing Address - City:CANDIA
Mailing Address - State:NH
Mailing Address - Zip Code:03034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 RAYMOND ROAD
Practice Address - Street 2:
Practice Address - City:CANDIA
Practice Address - State:NH
Practice Address - Zip Code:03034
Practice Address - Country:US
Practice Address - Phone:603-483-2176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3965122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty