Provider Demographics
NPI:1629303086
Name:DENTAL ARTS OF BEDFORD
Entity Type:Organization
Organization Name:DENTAL ARTS OF BEDFORD
Other - Org Name:BIRCHCROFT FAMILY DENTAL PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROLKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-647-2278
Mailing Address - Street 1:40 S RIVER RD
Mailing Address - Street 2:BEDFORD PLACE UNIT #33
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6719
Mailing Address - Country:US
Mailing Address - Phone:603-647-2278
Mailing Address - Fax:603-622-1616
Practice Address - Street 1:40 S RIVER RD
Practice Address - Street 2:BEDFORD PLACE UNIT #33
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6719
Practice Address - Country:US
Practice Address - Phone:603-647-2278
Practice Address - Fax:603-622-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3118122300000X
NH35351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30314423Medicaid