Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 03311 | NH |
NPI | 1093959595 |
---|---|
Provider Name | Jennie P Carcaud-Hennigar |
First Address | Tamworth, NH 03886-4626 |
Second Address | Tamworth, NH 03886-4626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2009 |
Last Update Date | 28/04/2009 |