Provider Demographics
NPI:1912087081
Name:VACHON, RICHARD E (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:VACHON
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 1:57 WEBSTER ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2552
Mailing Address - Country:US
Mailing Address - Phone:603-627-2092
Mailing Address - Fax:603-627-6585
Practice Address - Street 1:57 WEBSTER ST
Practice Address - Street 2:SUITE 112
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2552
Practice Address - Country:US
Practice Address - Phone:603-627-2092
Practice Address - Fax:603-627-6585
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0201935Y0NH01OtherANTHEM BCBS
NH89191935Medicaid
MAXR0074OtherBCBS