Provider Demographics
NPI:1194786954
Name:GORHAM FAMILY DENTISTRY, P.A.
Entity type:Organization
Organization Name:GORHAM FAMILY DENTISTRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-466-2323
Mailing Address - Street 1:18 PARK ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03581-1607
Mailing Address - Country:US
Mailing Address - Phone:603-466-2323
Mailing Address - Fax:
Practice Address - Street 1:18 PARK ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:NH
Practice Address - Zip Code:03581-1607
Practice Address - Country:US
Practice Address - Phone:603-466-2323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty