Provider Demographics
NPI:1740598325
Name:VACHON DENTAL PLLC
Entity Type:Organization
Organization Name:VACHON DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:VACHON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-627-2092
Mailing Address - Street 1:57 WEBSTER STREET
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2552
Mailing Address - Country:US
Mailing Address - Phone:603-627-2092
Mailing Address - Fax:603-606-3398
Practice Address - Street 1:57 WEBSTER STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2552
Practice Address - Country:US
Practice Address - Phone:603-627-2092
Practice Address - Fax:603-606-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH37991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3077699Medicaid