Provider Demographics
NPI:1235431610
Name:GREATER DERRY ORAL HEALTH COLLABORATIVE CORPORATION
Entity Type:Organization
Organization Name:GREATER DERRY ORAL HEALTH COLLABORATIVE CORPORATION
Other - Org Name:CHILDREN'S DENTAL NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-434-2327
Mailing Address - Street 1:2 WINDHAM DEPOT ROAD, SUITE 3L
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038
Mailing Address - Country:US
Mailing Address - Phone:603-434-2397
Mailing Address - Fax:603-432-1235
Practice Address - Street 1:2 WINDHAM DEPOT ROAD, SUITE 3L
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038
Practice Address - Country:US
Practice Address - Phone:603-434-2327
Practice Address - Fax:603-432-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1213124Q00000X, 124Q00000X
NH00906124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty