Provider Demographics
NPI:1992806681
Name:LONDONDERRY ORAL SURGERY PLLC
Entity type:Organization
Organization Name:LONDONDERRY ORAL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE STAFF
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:REDSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-893-7601
Mailing Address - Street 1:12 PARMENTER RD
Mailing Address - Street 2:UNIT A2
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3280
Mailing Address - Country:US
Mailing Address - Phone:603-893-7601
Mailing Address - Fax:603-890-1179
Practice Address - Street 1:12 PARMENTER RD
Practice Address - Street 2:UNIT A2
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3280
Practice Address - Country:US
Practice Address - Phone:603-893-7601
Practice Address - Fax:603-890-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH30521223S0112X
MA143681223S0112X
NH32651223S0112X
MA204611223S0112X
NH34221223S0112X
MA211071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHLORE7225Medicare ID - Type UnspecifiedMEDICARE