Provider Demographics
NPI:1356411839
Name:FAMILY DENTAL CARE OF MILFORD, PROF. ASSN.
Entity type:Organization
Organization Name:FAMILY DENTAL CARE OF MILFORD, PROF. ASSN.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DREW
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-673-3332
Mailing Address - Street 1:PO BOX 135
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-0135
Mailing Address - Country:US
Mailing Address - Phone:603-673-3332
Mailing Address - Fax:603-672-5844
Practice Address - Street 1:154 ELM ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4759
Practice Address - Country:US
Practice Address - Phone:603-673-3332
Practice Address - Fax:603-672-5844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty