Provider Demographics
NPI:1750992525
Name:DOMENICHELLO, SAMANTHA KAITLYN (RDH)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:KAITLYN
Last Name:DOMENICHELLO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 DURGIN RD
Mailing Address - Street 2:
Mailing Address - City:CHICHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03258-6300
Mailing Address - Country:US
Mailing Address - Phone:603-630-8691
Mailing Address - Fax:
Practice Address - Street 1:24 ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:NH
Practice Address - Zip Code:03261-3519
Practice Address - Country:US
Practice Address - Phone:603-942-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist