Provider Demographics
NPI:1588770614
Name:DAHLGREN, BRIAN EDWARD (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:EDWARD
Last Name:DAHLGREN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249 RTE 125
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03825-0249
Mailing Address - Country:US
Mailing Address - Phone:603-664-2722
Mailing Address - Fax:603-664-5461
Practice Address - Street 1:251 ROUTE 125
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NH
Practice Address - Zip Code:03825-0249
Practice Address - Country:US
Practice Address - Phone:603-664-9940
Practice Address - Fax:603-664-5461
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1630122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist