Provider Demographics
NPI:1912176744
Name:MONADNOCK DENTAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:MONADNOCK DENTAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ZANE
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:BROOME
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-532-8720
Mailing Address - Street 1:123 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:JAFFREY
Mailing Address - State:NH
Mailing Address - Zip Code:03452
Mailing Address - Country:US
Mailing Address - Phone:603-532-8720
Mailing Address - Fax:603-532-5618
Practice Address - Street 1:123 MAIN STREET
Practice Address - Street 2:
Practice Address - City:JAFFREY
Practice Address - State:NH
Practice Address - Zip Code:03452
Practice Address - Country:US
Practice Address - Phone:603-532-8720
Practice Address - Fax:603-532-5618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty