Provider Demographics
NPI:1841698156
Name:SOGOLE S MOIN PLLC
Entity type:Organization
Organization Name:SOGOLE S MOIN PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOGOLE
Authorized Official - Middle Name:SIBYL
Authorized Official - Last Name:MOIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-669-4503
Mailing Address - Street 1:765 S MAIN ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-5141
Mailing Address - Country:US
Mailing Address - Phone:603-669-4503
Mailing Address - Fax:
Practice Address - Street 1:765 S MAIN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-5141
Practice Address - Country:US
Practice Address - Phone:603-669-4503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3862261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental