Provider Demographics
NPI:1326251935
Name:WILLLIAM A. MEHAN, DMD PROFESSIONAL ASSOC.
Entity Type:Organization
Organization Name:WILLLIAM A. MEHAN, DMD PROFESSIONAL ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-623-8003
Mailing Address - Street 1:113 MAMMOTH RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109-4337
Mailing Address - Country:US
Mailing Address - Phone:603-623-8003
Mailing Address - Fax:603-623-1191
Practice Address - Street 1:113 MAMMOTH RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-4337
Practice Address - Country:US
Practice Address - Phone:603-623-8003
Practice Address - Fax:603-623-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1423OtherDENTAL LICENSE NUMBER