Provider Demographics
NPI:1598872350
Name:ADI ADVANCED DIGITAL IMAGING PLLC
Entity Type:Organization
Organization Name:ADI ADVANCED DIGITAL IMAGING PLLC
Other - Org Name:ADI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOUSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-893-1893
Mailing Address - Street 1:PO BOX 1784
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079
Mailing Address - Country:US
Mailing Address - Phone:603-893-1893
Mailing Address - Fax:603-893-2456
Practice Address - Street 1:32 STILES ROAD
Practice Address - Street 2:SUITE 206
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079
Practice Address - Country:US
Practice Address - Phone:603-893-1893
Practice Address - Fax:603-893-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty