Organization
BACKBAY DENTAL, LLC
Active
Other names
Back Bay Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS THOMAS CIANCARELLI D.M.D. (MANAGER)
(603) 569-1554
Entity
Organization
Contact information
Practice address
51 MILL ST, WOLFEBORO, NH 03894-4361
(603) 569-1554
Mailing address
51 MILL ST, WOLFEBORO, NH 03894-4361
(603) 569-1554
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134345945
—
MA
Enumeration date
09/23/2020
Last updated
09/23/2020
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