Provider Demographics
NPI:1568951457
Name:LONDONDERRY DENTISTRY & IMPLANTS, PLLC
Entity Type:Organization
Organization Name:LONDONDERRY DENTISTRY & IMPLANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANKSCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-997-0569
Mailing Address - Street 1:75 GILCREAST RD UNIT 108
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3565
Mailing Address - Country:US
Mailing Address - Phone:603-434-9329
Mailing Address - Fax:860-437-1938
Practice Address - Street 1:75 GILCREAST RD UNIT 108
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3565
Practice Address - Country:US
Practice Address - Phone:603-434-9329
Practice Address - Fax:860-437-1938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH035611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH03561OtherNH DENTAL LICENSE
NH3074071Medicaid