Provider Demographics
NPI:1497948988
Name:NEW HAMPSHIRE DENTAL HYGIENISTS ASSOCIATION
Entity Type:Organization
Organization Name:NEW HAMPSHIRE DENTAL HYGIENISTS ASSOCIATION
Other - Org Name:CONCORD DENTAL SEALANT COALITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FISCALAGENT-CONCORD DENTAL SEALANT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, BS
Authorized Official - Phone:603-759-8439
Mailing Address - Street 1:99 CLINTON ST
Mailing Address - Street 2:A-9
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:603-759-8439
Mailing Address - Fax:603-715-5415
Practice Address - Street 1:99 CLINTON ST
Practice Address - Street 2:A-9 CONCORD SCHOOL SYSTEM
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-759-8439
Practice Address - Fax:603-715-5415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30536696Medicaid