Provider Demographics
NPI:1336654862
Name:MANCHESTER DENTISTRY & IMPLANTS PLLC
Entity Type:Organization
Organization Name:MANCHESTER DENTISTRY & IMPLANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANKSCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-997-0569
Mailing Address - Street 1:12 DEER RUN DR
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2033
Mailing Address - Country:US
Mailing Address - Phone:860-997-0569
Mailing Address - Fax:860-437-1938
Practice Address - Street 1:43 DUNCAN FARMS
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-2363
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty