Provider Demographics
NPI:1356974653
Name:SMEAD, COLEEN M (RDH)
Entity type:Individual
Prefix:
First Name:COLEEN
Middle Name:M
Last Name:SMEAD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:COLEEN
Other - Middle Name:M
Other - Last Name:SMEAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:31 LIL NOR AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-1907
Mailing Address - Country:US
Mailing Address - Phone:603-502-6546
Mailing Address - Fax:
Practice Address - Street 1:801 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2529
Practice Address - Country:US
Practice Address - Phone:603-742-8844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-15
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist