Provider Demographics
NPI:1760693881
Name:NORTHEAST ENDODONTIC SPECIALISTS, PA
Entity Type:Organization
Organization Name:NORTHEAST ENDODONTIC SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-661-7702
Mailing Address - Street 1:PO BOX 1583
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-1583
Mailing Address - Country:US
Mailing Address - Phone:603-423-0400
Mailing Address - Fax:603-423-0401
Practice Address - Street 1:382 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-1583
Practice Address - Country:US
Practice Address - Phone:603-423-0400
Practice Address - Fax:603-423-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH30491223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty