Individual
DALE COLLINS VIDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
127 MASCOMA ST, LEBANON, NH 03766-2661
(603) 443-9572
(603) 443-9521
Mailing address
10 ALICE PECK DAY DR, LEBANON, NH 03766-2900
(603) 448-3121
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
9412
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0RE3751
—
VT
05
—
30008405
—
NH
Enumeration date
07/18/2006
Last updated
05/08/2017
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