Provider Demographics
NPI:1801454525
Name:HENNESSY, ALYSSA JANE BEACH (DMD)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:JANE BEACH
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MAIN ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NH
Mailing Address - Zip Code:03887-4420
Mailing Address - Country:US
Mailing Address - Phone:207-475-7443
Mailing Address - Fax:
Practice Address - Street 1:24 MAIN ST UNIT 3
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NH
Practice Address - Zip Code:03887-4420
Practice Address - Country:US
Practice Address - Phone:207-475-7443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN74111223G0001X
NH049581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice