Provider Demographics
NPI:1578681417
Name:ALLIANCE FOR DENTAL CARE, PLLC
Entity Type:Organization
Organization Name:ALLIANCE FOR DENTAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:LAURION
Authorized Official - Last Name:GOODSPEED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-332-7300
Mailing Address - Street 1:40 WINTER ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-3153
Mailing Address - Country:US
Mailing Address - Phone:603-332-7300
Mailing Address - Fax:603-332-7331
Practice Address - Street 1:40 WINTER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3153
Practice Address - Country:US
Practice Address - Phone:603-332-7300
Practice Address - Fax:603-332-7331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH19461223G0001X
NH33701223G0001X
NH9271223G0001X
NH035381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH50Y141600NH01OtherBCBS GROUP NUMBER
NH898915OtherUNITED CONCORDIA GROUP #
NH30313822Medicaid