Provider Demographics
NPI:1578671806
Name:PISCATAQUA DENTAL PARTNERS PA
Entity Type:Organization
Organization Name:PISCATAQUA DENTAL PARTNERS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:YEATON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-431-4559
Mailing Address - Street 1:288 LAFAYETTE ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:603-431-4559
Mailing Address - Fax:603-431-7560
Practice Address - Street 1:288 LAFAYETTE ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-431-4559
Practice Address - Fax:603-431-7560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010386Medicaid
460017OtherUNITED CONCORDIA