Provider Demographics
NPI:1437545829
Name:LINCOLN PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:LINCOLN PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:F
Authorized Official - Last Name:CAPOZZI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-745-7266
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:25 SO. MTN. DR., A-3
Mailing Address - City:LINCOLN
Mailing Address - State:NH
Mailing Address - Zip Code:03251
Mailing Address - Country:US
Mailing Address - Phone:603-745-7266
Mailing Address - Fax:
Practice Address - Street 1:25 SOUTH MOUNTAIN RD.
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NH
Practice Address - Zip Code:03251
Practice Address - Country:US
Practice Address - Phone:603-745-7266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3561302F00000X
NH3893302F00000X
NH3970302F00000X
NH3005302R00000X
NJ3985302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3071172Medicaid
NH3082161Medicaid
NH3071357Medicaid
NH3077206Medicaid
NH3078338Medicaid
NH3085887Medicaid