Provider Demographics
NPI:1689773426
Name:FISICHELLI, BEACH & BRAR PROFESSIONAL ASSN.
Entity Type:Organization
Organization Name:FISICHELLI, BEACH & BRAR PROFESSIONAL ASSN.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARJEET
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-889-0601
Mailing Address - Street 1:33 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-2014
Mailing Address - Country:US
Mailing Address - Phone:603-889-0601
Mailing Address - Fax:603-889-3060
Practice Address - Street 1:33 BROAD ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064-2014
Practice Address - Country:US
Practice Address - Phone:603-889-0601
Practice Address - Fax:603-889-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH31951223G0001X
NH10811223G0001X
NH039911223G0001X
NH11751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30312675Medicaid