Provider Demographics
NPI:1023281599
Name:MONADNOCK HEALTHY TEETH
Entity type:Organization
Organization Name:MONADNOCK HEALTHY TEETH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEINBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-924-7191
Mailing Address - Street 1:452 OLD STREET RD
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1263
Mailing Address - Country:US
Mailing Address - Phone:603-924-7191
Mailing Address - Fax:603-924-9586
Practice Address - Street 1:452 OLD STREET RD
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1263
Practice Address - Country:US
Practice Address - Phone:603-924-7191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONADNOCK COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-07
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30312651Medicaid