| Back Bay Dental | |
|
51 Mill St Wolfeboro NH 03894-4361 | |
| (603) 569-1554 | |
| Not Available |
| Full Name | Back Bay Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 51 Mill St, Wolfeboro, New Hampshire |
| Authorized Official Name and Position | Nicholas Thomas Ciancarelli (MANAGER) |
| Authorized Official Contact | 6035691554 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Back Bay Dental 51 Mill St Wolfeboro NH 03894-4361 Ph: (603) 569-1554 | Back Bay Dental 51 Mill St Wolfeboro NH 03894-4361 Ph: (603) 569-1554 |
| NPI Number | 1164039277 |
|---|---|
| Provider Enumeration Date | 09/23/2020 |
| Last Update Date | 09/23/2020 |
| Certification Date | 09/23/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164039277 | NPI | - | NPPES |
| 1134345945 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (NU) | Primary |
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