Provider Demographics
NPI:1992196745
Name:DUPONT, SHELLEY M (RDH)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:M
Last Name:DUPONT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHICHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03258-6510
Mailing Address - Country:US
Mailing Address - Phone:603-344-3171
Mailing Address - Fax:
Practice Address - Street 1:24 ROCHESTER RD.
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:NH
Practice Address - Zip Code:03261
Practice Address - Country:US
Practice Address - Phone:603-942-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1542124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist