Provider Demographics
NPI:1821196015
Name:SHRECK, CAROLYN MARGARET EVELYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:MARGARET EVELYN
Last Name:SHRECK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CAROLYN
Other - Middle Name:MARGARET EVELYN
Other - Last Name:MANKIEWICZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:37 EPPING STREET
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03077
Mailing Address - Country:US
Mailing Address - Phone:603-895-3161
Mailing Address - Fax:603-895-3993
Practice Address - Street 1:37 EPPING STREET
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:NH
Practice Address - Zip Code:03077
Practice Address - Country:US
Practice Address - Phone:603-895-3161
Practice Address - Fax:603-895-3993
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH33501223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3350OtherSTATE