Organization
HANOVER ROAD DENTAL HEALTH, PA
Active
Other names
Kenneth W. Olsen, D.M.D., P.A.
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY BRADIGAN D.D.S. (OWNER)
(603) 643-4362
Entity
Organization
Contact information
Practice address
367 ROUTE 120 BLDG. D, LEBANON, NH 03766
(603) 643-4362
(603) 643-4340
Mailing address
367 ROUTE 120 BLDG. D, LEBANON, NH 03766
(603) 643-4362
(603) 643-4340
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2601
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30314128
—
NH
05
—
3071380
—
NH
Enumeration date
11/20/2006
Last updated
06/02/2015
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