Provider Demographics
NPI:1417055047
Name:MONADNOCK ORTHODONTICS, P.C.
Entity Type:Organization
Organization Name:MONADNOCK ORTHODONTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-924-3040
Mailing Address - Street 1:166 HANCOCK RD
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-2106
Mailing Address - Country:US
Mailing Address - Phone:603-924-3040
Mailing Address - Fax:603-924-8502
Practice Address - Street 1:166 HANCOCK RD
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-2106
Practice Address - Country:US
Practice Address - Phone:603-924-3040
Practice Address - Fax:603-924-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30007750Medicaid