Provider Demographics
NPI:1164961611
Name:SEACOAST CHILDREN'S DENTISTRY
Entity Type:Organization
Organization Name:SEACOAST CHILDREN'S DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JOASH
Authorized Official - Last Name:BOTTRILL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-319-4101
Mailing Address - Street 1:13 MARCH FARM WAY
Mailing Address - Street 2:UNIT A
Mailing Address - City:GREENLAND
Mailing Address - State:NH
Mailing Address - Zip Code:03840
Mailing Address - Country:US
Mailing Address - Phone:603-319-4101
Mailing Address - Fax:
Practice Address - Street 1:13 MARCH FARM WAY
Practice Address - Street 2:UNIT A
Practice Address - City:GREENLAND
Practice Address - State:NH
Practice Address - Zip Code:03840
Practice Address - Country:US
Practice Address - Phone:603-319-4101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03849261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental