Provider Demographics
NPI:1841640810
Name:LITTLETON DENTURES & IMPLANTS PLLC
Entity type:Organization
Organization Name:LITTLETON DENTURES & IMPLANTS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLANKSCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-997-0569
Mailing Address - Street 1:130 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-4203
Mailing Address - Country:US
Mailing Address - Phone:603-444-2588
Mailing Address - Fax:603-444-2551
Practice Address - Street 1:130 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-4203
Practice Address - Country:US
Practice Address - Phone:603-444-2588
Practice Address - Fax:603-444-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03516122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1881981264OtherNPI
1114950607OtherNPI