Provider Demographics
NPI:1083860738
Name:EXCEPTIONAL DENTISTRY
Entity type:Organization
Organization Name:EXCEPTIONAL DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-890-4004
Mailing Address - Street 1:1 STILES RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-4859
Mailing Address - Country:US
Mailing Address - Phone:603-890-4004
Mailing Address - Fax:603-890-4003
Practice Address - Street 1:1 STILES RD
Practice Address - Street 2:102
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-4859
Practice Address - Country:US
Practice Address - Phone:603-890-4004
Practice Address - Fax:603-890-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03363122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH6384940001Medicare NSC