Provider Demographics
NPI:1255671178
Name:SEASIDE SMILES, PLLC
Entity Type:Organization
Organization Name:SEASIDE SMILES, PLLC
Other - Org Name:LAKESIDE SMILES PEDIATRIC DENTISTRY, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-280-4500
Mailing Address - Street 1:PO BOX 1498
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:NH
Mailing Address - Zip Code:03809-1498
Mailing Address - Country:US
Mailing Address - Phone:603-280-4500
Mailing Address - Fax:603-632-3620
Practice Address - Street 1:82 MAIN ST.
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:NH
Practice Address - Zip Code:03809-1498
Practice Address - Country:US
Practice Address - Phone:603-280-4500
Practice Address - Fax:603-632-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-01
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN170861223P0221X
1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3108842Medicaid