Provider Demographics
NPI:1801097654
Name:GRANITE STATE ORAL SURGERY PLLC
Entity type:Organization
Organization Name:GRANITE STATE ORAL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALMAN
Authorized Official - Middle Name:AYUB
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:603-432-3308
Mailing Address - Street 1:80 NASHUA RD
Mailing Address - Street 2:BUILDING C
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3426
Mailing Address - Country:US
Mailing Address - Phone:603-432-3308
Mailing Address - Fax:603-425-6165
Practice Address - Street 1:80 NASHUA RD
Practice Address - Street 2:BUILDING C
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3426
Practice Address - Country:US
Practice Address - Phone:603-432-3308
Practice Address - Fax:603-425-6165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH30251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1417977737OtherTYPE 1 NPI
NH30312701Medicaid
NH0206381Y0NH01OtherANTHEM ID
NH30312701Medicaid
NHRE4702Medicare ID - Type Unspecified
NH30312701Medicaid