Provider Demographics
NPI:1720026263
Name:PAISNER, ELIOT LAWRENCE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELIOT
Middle Name:LAWRENCE
Last Name:PAISNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 NORTHEASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3179
Mailing Address - Country:US
Mailing Address - Phone:603-883-6546
Mailing Address - Fax:603-595-1826
Practice Address - Street 1:78 NORTHEASTERN BLVD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-3179
Practice Address - Country:US
Practice Address - Phone:603-883-6546
Practice Address - Fax:603-595-1826
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH89191931Medicaid
NHPAIS191931OtherBLUE CROSS BLUE SHIELD