Provider Demographics
NPI:1215196837
Name:BEDFORD DENTAL CENTER PC
Entity Type:Organization
Organization Name:BEDFORD DENTAL CENTER PC
Other - Org Name:BEDFORD DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-625-2193
Mailing Address - Street 1:207 MEETINGHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6090
Mailing Address - Country:US
Mailing Address - Phone:603-625-2193
Mailing Address - Fax:603-669-9100
Practice Address - Street 1:207 MEETINGHOUSE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6090
Practice Address - Country:US
Practice Address - Phone:603-625-2193
Practice Address - Fax:603-669-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH34821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty