Provider Demographics
NPI:1730338229
Name:ABENAKI DENTAL CARE
Entity type:Organization
Organization Name:ABENAKI DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HEIMBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-583-4533
Mailing Address - Street 1:1 HAMPTON RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-4848
Mailing Address - Country:US
Mailing Address - Phone:603-583-4533
Mailing Address - Fax:603-583-4507
Practice Address - Street 1:1 HAMPTON RD
Practice Address - Street 2:SUITE 305
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4848
Practice Address - Country:US
Practice Address - Phone:603-583-4533
Practice Address - Fax:603-583-4507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3407261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental