Organization Name: | CAPITOL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, PLLC |
NPI Number: | 1316151798 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICHARD J ROSATO (OWNER) |
Mailing Address: | 129 Wilton Rd Suite B Peterborough |
State: | NH US |
Postal Code: | 034581749 |
Phone Number: | 6037845447 |
Fax Number: | 6037845449 |
NPI Enumeration Date: | 05/09/2007 |
NPI Last Update Date: | 08/14/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 204E00000X |
License Number: | 3188 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NH |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Oral & Maxillofacial Surgery |
Taxonomy Specialization: | |
Taxonomy Definition: |