Provider Demographics
NPI:1336343979
Name:HEALTHY SMILES P.A.
Entity Type:Organization
Organization Name:HEALTHY SMILES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-749-0700
Mailing Address - Street 1:184 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3737
Mailing Address - Country:US
Mailing Address - Phone:603-749-0700
Mailing Address - Fax:
Practice Address - Street 1:184 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3737
Practice Address - Country:US
Practice Address - Phone:603-749-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHY SMILES P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-14
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty