Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 1526 | NH |
NPI | 1407961063 |
---|---|
Provider Name | Thomas Shealy III |
First Address | Stratham, NH 03885 |
Second Address | Stratham, NH 03885 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |