NPIMap

Organization Active NPI

Lifetime Dental Professionals of New Hampshire, P.C.

  • General Practice Dentistry
  • Plymouth, NH
National Provider Identifier
1497979918
Registry record updated Mar 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LIFETIME DENTAL PROFESSIONALS OF NEW HAMPSHIRE, P.C.
Practice address
107 Main Street
Plymouth, NH 03264
Phone
(603) 536-4009
Fax
(603) 536-1033
NPI assigned
Apr 13, 2007
Organization subpart
Yes
Parent organization
LIFETIME DENTAL PROFESSIONALS OF NEW HAMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 29, 2016

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

Authorized official

Name
Lori Edmonds
Title
Credentialing Coordinator
Phone
(217) 540-8468

Specialties & licenses 2

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

Addresses

Primary practice location

107 Main Street
Plymouth, NH 03264

Mailing address

107 Main Street
Plymouth, NH 03264
Phone (603) 536-4009

Other identifiers 1

IdentifierTypeStateIssuer
30300441MedicaidNH

Other names 1

  • Main Street Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lifetime Dental Professionals of New Hampshire PC5 organizations share this tax ID, including this one
Part of
Lifetime Dental Professionals of New Hampshire PC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

107 Main St
Plymouth, NH 03264
Phone (603) 536-4009

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": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459209600000",
    "number": "1497979918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 MAIN STREET",
            "city": "PLYMOUTH",
            "state": "NH",
            "postal_code": "03264",
            "telephone_number": "603-536-4009",
            "fax_number": "603-536-1033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 MAIN STREET",
            "city": "PLYMOUTH",
            "state": "NH",
            "postal_code": "03264",
            "telephone_number": "603-536-4009",
            "fax_number": "603-536-1033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME DENTAL PROFESSIONALS OF NEW HAMPSHIRE, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFETIME DENTAL PROFESSIONALS OF NEW HAM",
        "enumeration_date": "2007-04-13",
        "last_updated": "2016-03-29",
        "status": "A",
        "authorized_official_last_name": "EDMONDS",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8468"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NH",
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30300441",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plymouth, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2016; 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.