Provider Demographics
NPI:1437355310
Name:NORTH COUNTRY ORAL AND MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:NORTH COUNTRY ORAL AND MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-444-0003
Mailing Address - Street 1:262 COTTAGE ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-4143
Mailing Address - Country:US
Mailing Address - Phone:603-444-0003
Mailing Address - Fax:603-444-9401
Practice Address - Street 1:262 COTTAGE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-4143
Practice Address - Country:US
Practice Address - Phone:603-444-0003
Practice Address - Fax:603-444-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH34751223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30308008Medicaid
NH02Y011170NH01OtherANTHEM