Provider Demographics
NPI:1710334834
Name:MONDOVI DENTAL OF NEW HAMPSHIRE PC
Entity Type:Organization
Organization Name:MONDOVI DENTAL OF NEW HAMPSHIRE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:715-926-5050
Mailing Address - Street 1:340 WEST ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-2446
Mailing Address - Country:US
Mailing Address - Phone:603-352-1913
Mailing Address - Fax:603-352-1930
Practice Address - Street 1:340 WEST ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-2446
Practice Address - Country:US
Practice Address - Phone:603-352-1913
Practice Address - Fax:603-352-1930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty