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Organization
LAKES REGION DENTAL IMPLANT AND ORAL SURGERY CENTER, P.A.
Active
Organization
LAKES REGION DENTAL IMPLANT AND ORAL SURGERY CENTER, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL HENRY DETOLLA DDS, MD (PRESIDENT)
(603) 436-3608
Entity
Organization
Contact information
Practice address
369 HOUNSELL AVE, SUITE 2, GILFORD, NH 03249
(603) 527-8057
(603) 527-8159
Mailing address
369 HOUNSELL AVE, SUITE 2, GILFORD, NH 03249
(603) 527-8057
(603) 527-8159
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
NULL
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
—
Other
Enumeration date
04/07/2011
Last updated
04/07/2011
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