Provider Demographics
NPI:1437166584
Name:WHITE MOUNTAIN ORAL & MAXILLOFACIAL SURGERY, PC
Entity Type:Organization
Organization Name:WHITE MOUNTAIN ORAL & MAXILLOFACIAL SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-356-9755
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-1289
Mailing Address - Country:US
Mailing Address - Phone:603-356-9755
Mailing Address - Fax:603-356-9754
Practice Address - Street 1:3277 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5113
Practice Address - Country:US
Practice Address - Phone:603-356-9755
Practice Address - Fax:603-356-9754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery