Provider Demographics
NPI:1568675072
Name:BRIAN J MAHONEY DMD PA
Entity Type:Organization
Organization Name:BRIAN J MAHONEY DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-622-2425
Mailing Address - Street 1:20 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2544
Mailing Address - Country:US
Mailing Address - Phone:603-622-2425
Mailing Address - Fax:603-668-3855
Practice Address - Street 1:20 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2544
Practice Address - Country:US
Practice Address - Phone:603-622-2425
Practice Address - Fax:603-668-3855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty