Provider Demographics
NPI:1770100810
Name:ALBRECHT, DEBRA
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:ALBRECHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 961
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-0961
Mailing Address - Country:US
Mailing Address - Phone:603-313-0656
Mailing Address - Fax:
Practice Address - Street 1:31 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7425
Practice Address - Country:US
Practice Address - Phone:603-313-0656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-05
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1326124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist