Provider Demographics
NPI:1275884132
Name:BRENTWOOD DENTAL DESIGNS, PLLC
Entity Type:Organization
Organization Name:BRENTWOOD DENTAL DESIGNS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMATHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-679-3679
Mailing Address - Street 1:1 BRICKYARD SQ
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EPPING
Mailing Address - State:NH
Mailing Address - Zip Code:03042-4402
Mailing Address - Country:US
Mailing Address - Phone:603-679-3679
Mailing Address - Fax:603-679-3779
Practice Address - Street 1:1 BRICKYARD SQ
Practice Address - Street 2:SUITE 5
Practice Address - City:EPPING
Practice Address - State:NH
Practice Address - Zip Code:03042-4402
Practice Address - Country:US
Practice Address - Phone:603-679-3679
Practice Address - Fax:603-679-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03591261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental