Provider Demographics
NPI:1407901697
Name:MOUNTAIN VIEW DENTAL PA
Entity Type:Organization
Organization Name:MOUNTAIN VIEW DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BREWSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, CST
Authorized Official - Phone:603-837-9342
Mailing Address - Street 1:8 CLOVER LANE
Mailing Address - Street 2:STE 2
Mailing Address - City:WHITEFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03598-0239
Mailing Address - Country:US
Mailing Address - Phone:603-837-9342
Mailing Address - Fax:603-837-2890
Practice Address - Street 1:8 CLOVER LANE
Practice Address - Street 2:STE. 2
Practice Address - City:WHITEFIELD
Practice Address - State:NH
Practice Address - Zip Code:03598-0239
Practice Address - Country:US
Practice Address - Phone:603-837-9342
Practice Address - Fax:603-837-2890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30314728Medicaid