Provider Demographics
NPI:1780711481
Name:DOVER FOOT SPECIALTY CENTER, PC
Entity type:Organization
Organization Name:DOVER FOOT SPECIALTY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:603-742-2245
Mailing Address - Street 1:750 CENTRAL AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3434
Mailing Address - Country:US
Mailing Address - Phone:603-742-2245
Mailing Address - Fax:603-742-0712
Practice Address - Street 1:750 CENTRAL AVE
Practice Address - Street 2:SUITE J
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3434
Practice Address - Country:US
Practice Address - Phone:603-742-2245
Practice Address - Fax:603-742-0712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0187213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1285618678OtherNPI BESSETTE
NH1467436857OtherNPI GOULD
NH30362836Medicaid
NH80008271Medicaid
NHRE6218Medicare ID - Type UnspecifiedMARC R. BESSTETTE, DPM
NHNH8271Medicare ID - Type UnspecifiedWAYNE C. GOULD, DPM
NH4534100001Medicare NSC
NHU85904Medicare UPIN
NH80008271Medicaid