Provider Demographics
NPI:1144272352
Name:CONCORD ORAL SURGERY PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:CONCORD ORAL SURGERY PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCURA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-225-3482
Mailing Address - Street 1:194 PLEASANT ST
Mailing Address - Street 2:SUITE 13
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2952
Mailing Address - Country:US
Mailing Address - Phone:603-225-3482
Mailing Address - Fax:603-224-2331
Practice Address - Street 1:194 PLEASANT ST
Practice Address - Street 2:SUITE 13
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2952
Practice Address - Country:US
Practice Address - Phone:603-225-3482
Practice Address - Fax:603-224-2331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH21861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH89191315Medicaid
NH129OtherCIGNA
NHH000186OtherCHAMPUS
NH1053OtherNORTHEAST DELTA DENTAL
NHCONC1315OtherBLUE CROSS/BLUE SHIELD
NH89191315Medicaid
NH89191315Medicaid