Provider Demographics
NPI:1932509148
Name:GREAT BAY DENTAL CARE
Entity Type:Organization
Organization Name:GREAT BAY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOSLEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-659-3341
Mailing Address - Street 1:48 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWMARKET
Mailing Address - State:NH
Mailing Address - Zip Code:03857-1210
Mailing Address - Country:US
Mailing Address - Phone:603-659-3341
Mailing Address - Fax:603-659-4418
Practice Address - Street 1:48 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWMARKET
Practice Address - State:NH
Practice Address - Zip Code:03857-1210
Practice Address - Country:US
Practice Address - Phone:603-659-3341
Practice Address - Fax:603-659-4418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH036811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty