Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 2583 | NH |
NPI | 1124039003 |
---|---|
Provider Name | Dr. Richard G Berube |
First Address | Bow, NH 03304-4214 |
Second Address | Manchester, NH 03101-1699 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 08/07/2007 |