Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 2667 | NH |
NPI | 1154473767 |
---|---|
Provider Name | Dr. Douglas H Moll |
First Address | Concord, NH 03301-5321 |
Second Address | Concord, NH 03301-5321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 08/07/2007 |