NPIMap

Organization Active NPI

Hanover Road Dental Health, PA

  • General Practice Dentistry
  • Lebanon, NH
National Provider Identifier
1164596227
Registry record updated Jun 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2601 Issued in NH
Legal business name
HANOVER ROAD DENTAL HEALTH, PA
Practice address
367 Route 120 BLDG. D
Lebanon, NH 03766
Phone
(603) 643-4362
Fax
(603) 643-4340
NPI assigned
Nov 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Terry Bradigan, D.D.S.NPI 1538234380
Title
Owner
Phone
(603) 643-4362

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 2601 NH Primary

Addresses

Primary practice location

367 Route 120 BLDG. D
Lebanon, NH 03766

Mailing address

367 Route 120 BLDG. D
Lebanon, NH 03766
Phone (603) 643-4362

Other identifiers 2

IdentifierTypeStateIssuer
30314128MedicaidNH
3071380MedicaidNH

Other names 1

  • Kenneth W. Olsen, D.M.D., P.A. Former legal business name

National Provider Directory

National Provider Directory

Locations

367 State Route 120
Bldg D
Lebanon, NH 03766
Phone (603) 643-4362

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433203200000",
    "number": "1164596227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "367 ROUTE 120 BLDG. D",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "03766",
            "telephone_number": "603-643-4362",
            "fax_number": "603-643-4340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "367 ROUTE 120 BLDG. D",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "03766",
            "telephone_number": "603-643-4362",
            "fax_number": "603-643-4340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HANOVER ROAD DENTAL HEALTH, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2015-06-02",
        "status": "A",
        "authorized_official_last_name": "BRADIGAN",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "603-643-4362",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NH",
            "license": "2601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30314128",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3071380",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kenneth W. Olsen, D.M.D., P.A.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Lebanon, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.