Provider Demographics
NPI:1457556177
Name:MERRIMACK DENTAL PLLC
Entity type:Organization
Organization Name:MERRIMACK DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HEROD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-424-6131
Mailing Address - Street 1:P.O. BOX 189
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054
Mailing Address - Country:US
Mailing Address - Phone:603-424-6131
Mailing Address - Fax:603-424-3620
Practice Address - Street 1:170 SOUTH RIVER ROAD
Practice Address - Street 2:BUILDING II UNIT #4
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110
Practice Address - Country:US
Practice Address - Phone:603-424-6131
Practice Address - Fax:603-424-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH035121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty