Provider Demographics
NPI:1770795858
Name:FREDRICK M. VEGA, D.D.S., P.C.
Entity type:Organization
Organization Name:FREDRICK M. VEGA, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-485-8464
Mailing Address - Street 1:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:SUNCOOK
Mailing Address - State:NH
Mailing Address - Zip Code:03275
Mailing Address - Country:US
Mailing Address - Phone:603-485-8464
Mailing Address - Fax:
Practice Address - Street 1:50 PINEWOOD ROAD
Practice Address - Street 2:
Practice Address - City:ALLENSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03275
Practice Address - Country:US
Practice Address - Phone:603-485-8464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1857261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH89192070Medicaid