Provider Demographics
NPI:1912579053
Name:LONDON FAMILY ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:LONDON FAMILY ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LONDON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:603-622-2100
Mailing Address - Street 1:502 RIVERWAY PL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6766
Mailing Address - Country:US
Mailing Address - Phone:603-622-2100
Mailing Address - Fax:603-622-5665
Practice Address - Street 1:502 RIVERWAY PL
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6766
Practice Address - Country:US
Practice Address - Phone:603-622-2100
Practice Address - Fax:603-622-5665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental