Provider Demographics
NPI:1942474374
Name:ROGER LAMONTAGNE DMD
Entity Type:Organization
Organization Name:ROGER LAMONTAGNE DMD
Other - Org Name:FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMONTAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-622-7973
Mailing Address - Street 1:252 JEWETT ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-2823
Mailing Address - Country:US
Mailing Address - Phone:603-622-7973
Mailing Address - Fax:603-666-0613
Practice Address - Street 1:252 JEWETT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-2823
Practice Address - Country:US
Practice Address - Phone:603-622-7973
Practice Address - Fax:603-666-0613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH21061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30004874Medicaid