Provider Demographics
NPI:1245409150
Name:AMAZING SMILES FAMILY DENTAL CENTER
Entity Type:Organization
Organization Name:AMAZING SMILES FAMILY DENTAL CENTER
Other - Org Name:FREDRICK M. VEGA, D.D.S., P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-485-7600
Mailing Address - Street 1:311 W RIVER RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-2635
Mailing Address - Country:US
Mailing Address - Phone:603-485-7600
Mailing Address - Fax:
Practice Address - Street 1:311 W RIVER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106-2635
Practice Address - Country:US
Practice Address - Phone:603-485-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1857261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30313725NHMedicaid