Provider Demographics
NPI:1609811991
Name:DESMARAIS, PHILIP
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:DESMARAIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WALL ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3740
Mailing Address - Country:US
Mailing Address - Phone:603-224-9119
Mailing Address - Fax:603-223-9678
Practice Address - Street 1:2 WALL ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3740
Practice Address - Country:US
Practice Address - Phone:603-224-9119
Practice Address - Fax:603-223-9678
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics