Provider Demographics
NPI:1578589123
Name:COOLLEY, RITA M (RDH)
Entity Type:Individual
Prefix:MISS
First Name:RITA
Middle Name:M
Last Name:COOLLEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 881
Mailing Address - Street 2:
Mailing Address - City:GRANTHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03753-0881
Mailing Address - Country:US
Mailing Address - Phone:603-863-6530
Mailing Address - Fax:
Practice Address - Street 1:1 COURT ST
Practice Address - Street 2:SUITE 270
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1358
Practice Address - Country:US
Practice Address - Phone:603-448-1830
Practice Address - Fax:603-448-1826
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2204124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2204OtherRDH