Provider Demographics
NPI:1245628924
Name:NORTHWOOD FAMILY DENTAL CENTER, PLLC
Entity type:Organization
Organization Name:NORTHWOOD FAMILY DENTAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GOMES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:6039-425-5441
Mailing Address - Street 1:PO BOX 288
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:NH
Mailing Address - Zip Code:03261-0288
Mailing Address - Country:US
Mailing Address - Phone:603-942-5541
Mailing Address - Fax:603-942-8002
Practice Address - Street 1:1505 FIRST NEW HAMPSHIRE TPKE
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:NH
Practice Address - Zip Code:03261-3217
Practice Address - Country:US
Practice Address - Phone:603-942-5541
Practice Address - Fax:603-942-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH041001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty