Provider Demographics
NPI:1730708272
Name:ALTON BAY DENTAL PLLC
Entity type:Organization
Organization Name:ALTON BAY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:THIBEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-316-3328
Mailing Address - Street 1:PO BOX 1584
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:NH
Mailing Address - Zip Code:03809
Mailing Address - Country:US
Mailing Address - Phone:207-316-3328
Mailing Address - Fax:
Practice Address - Street 1:291 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:NH
Practice Address - Zip Code:03809
Practice Address - Country:US
Practice Address - Phone:603-855-2017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-14
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental