Provider Demographics
NPI:1346645884
Name:EMILY JEANNE SAMUEL
Entity Type:Organization
Organization Name:EMILY JEANNE SAMUEL
Other - Org Name:WALPOLE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-904-4150
Mailing Address - Street 1:PO BOX 815
Mailing Address - Street 2:24 WESTMINSTER STREET
Mailing Address - City:WALPOLE
Mailing Address - State:NH
Mailing Address - Zip Code:03608-0815
Mailing Address - Country:US
Mailing Address - Phone:603-904-4150
Mailing Address - Fax:
Practice Address - Street 1:24 WESTMINSTER STREET WEST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:NH
Practice Address - Zip Code:03608-0815
Practice Address - Country:US
Practice Address - Phone:603-904-4150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH031461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty