Provider Demographics
NPI:1326540253
Name:ONE COMMONS ENDODONTICS PLLC
Entity Type:Organization
Organization Name:ONE COMMONS ENDODONTICS PLLC
Other - Org Name:MODERN ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:MIRUCKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-552-3632
Mailing Address - Street 1:1F COMMONS DR UNIT 39
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3474
Mailing Address - Country:US
Mailing Address - Phone:603-552-3632
Mailing Address - Fax:603-818-4903
Practice Address - Street 1:1F COMMONS DR UNIT 39
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3474
Practice Address - Country:US
Practice Address - Phone:603-552-3632
Practice Address - Fax:603-818-4903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH039771223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty