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
—
—
Other
Enumeration date
04/07/2011
Last updated
04/07/2011
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