Provider Demographics
NPI:1457426686
Name:CORNERSTONE PERIODONTICS AND IMPLANTS PLLC
Entity Type:Organization
Organization Name:CORNERSTONE PERIODONTICS AND IMPLANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-224-9474
Mailing Address - Street 1:153 MANCHESTER ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:603-224-9474
Mailing Address - Fax:603-224-9232
Practice Address - Street 1:153 MANCHESTER ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-224-9474
Practice Address - Fax:603-224-9232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH32891223P0300X
NH32901223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHBV4747133OtherDEA PHARMACY
NHBW3885742OtherDEA PHARMACY