Provider Demographics
NPI:1417564857
Name:VIJ, HITESH (DMD)
Entity Type:Individual
Prefix:
First Name:HITESH
Middle Name:
Last Name:VIJ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 DOW ST STE 401
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-3200
Mailing Address - Country:US
Mailing Address - Phone:603-623-0641
Mailing Address - Fax:603-622-8350
Practice Address - Street 1:155 DOW ST STE 401
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-3200
Practice Address - Country:US
Practice Address - Phone:603-623-0641
Practice Address - Fax:603-622-8350
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist