Provider Demographics
NPI:1467960880
Name:ROBERT C. FROMUTH DDS PLLC
Entity Type:Organization
Organization Name:ROBERT C. FROMUTH DDS PLLC
Other - Org Name:FROMUTH AND LANGLOIS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FROMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-644-3368
Mailing Address - Street 1:765 S MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-5141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:765 S MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-5141
Practice Address - Country:US
Practice Address - Phone:603-644-3368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04072261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental