Provider Demographics
NPI:1538259221
Name:PARKWAY DENTAL ASSOCIATES
Entity type:Organization
Organization Name:PARKWAY DENTAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHAIKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-742-4735
Mailing Address - Street 1:40 CHESTNUT ST STE 2
Mailing Address - Street 2:BELKNAP DENTAL ASSOCIATION
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3335
Mailing Address - Country:US
Mailing Address - Phone:603-742-4735
Mailing Address - Fax:603-742-9911
Practice Address - Street 1:40 CHESTNUT ST STE 2
Practice Address - Street 2:BELKNAP DENTAL ASSOCIATION
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3335
Practice Address - Country:US
Practice Address - Phone:603-742-4735
Practice Address - Fax:603-742-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1245122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011191Medicaid
ME139160000Medicaid
KY111194OtherAETNA DMU
PA128085OtherUNITED CONCORDIA
PA128085OtherUNITED CONCORDIA