Provider Demographics
NPI:1548428212
Name:MICHAEL R DION DMD FAGD
Entity Type:Organization
Organization Name:MICHAEL R DION DMD FAGD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:DION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-434-0040
Mailing Address - Street 1:24 PINKERTON ST
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1504
Mailing Address - Country:US
Mailing Address - Phone:603-434-0040
Mailing Address - Fax:
Practice Address - Street 1:24 PINKERTON ST
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1504
Practice Address - Country:US
Practice Address - Phone:603-434-0040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH21911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30312306Medicaid