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Organization

GRACE FAMILY DENTISTRY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ALEX L MCCULLOCH DDS (DENTIST PARTNER)
(603) 225-6650
Entity
Organization

Contact information

Practice address
143 AIRPORT RD, CONCORD, NH 03301
(603) 225-6650
(603) 225-9495
Mailing address
143 AIRPORT RD, CONCORD, NH 03301
(603) 225-6650
(603) 225-9495

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
1478
NH
122300000X
Dentist
Primary
1604
NH
122300000X
Dentist
2389
NH
122300000X
Dentist
3170
NH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0206510Y0NH01
BLUE CROSS FEDERAL
NH
05
30004745
NH
Enumeration date
04/18/2006
Last updated
08/22/2020
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