Provider Demographics
NPI:1265444327
Name:WINGATE, JOSEPH LEON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LEON
Last Name:WINGATE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 GILCREAST RD
Mailing Address - Street 2:STE 104
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053
Mailing Address - Country:US
Mailing Address - Phone:603-434-5150
Mailing Address - Fax:603-434-0072
Practice Address - Street 1:75 GILCREAST RD
Practice Address - Street 2:STE 104
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053
Practice Address - Country:US
Practice Address - Phone:603-434-5150
Practice Address - Fax:603-434-0072
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH020176240NH2OtherBCBS FEDERAL
MAXR0085OtherBCBS
NH89191762Medicaid