Provider Demographics
NPI:1376712828
Name:MCWILLIAMS AND WONSAVAGE DENTISTRY PARTNERSHIP
Entity Type:Organization
Organization Name:MCWILLIAMS AND WONSAVAGE DENTISTRY PARTNERSHIP
Other - Org Name:LYME ROAD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCWILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PHD
Authorized Official - Phone:603-643-3104
Mailing Address - Street 1:71 LYME RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-1253
Mailing Address - Country:US
Mailing Address - Phone:603-643-3104
Mailing Address - Fax:603-643-0241
Practice Address - Street 1:71 LYME RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-1253
Practice Address - Country:US
Practice Address - Phone:603-643-3104
Practice Address - Fax:603-643-0241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty