Provider Demographics
NPI:1760736599
Name:PLYMOUTH GENERAL DENTISTRY, PLLC
Entity Type:Organization
Organization Name:PLYMOUTH GENERAL DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRSCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-536-4301
Mailing Address - Street 1:65 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-1232
Mailing Address - Country:US
Mailing Address - Phone:603-536-4301
Mailing Address - Fax:603-536-1984
Practice Address - Street 1:65 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-1232
Practice Address - Country:US
Practice Address - Phone:603-536-4301
Practice Address - Fax:603-536-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-31
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty