Provider Demographics
NPI:1548649890
Name:AUDC DENTAL GROUP PLLC
Entity type:Organization
Organization Name:AUDC DENTAL GROUP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDATI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-627-3927
Mailing Address - Street 1:324 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-4842
Mailing Address - Country:US
Mailing Address - Phone:603-627-3927
Mailing Address - Fax:
Practice Address - Street 1:324 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-4842
Practice Address - Country:US
Practice Address - Phone:603-627-3927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03648261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental