| Doctor Name: | SHERRY M BODGE |
| NPI Number: | 1003041609 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LD |
| License Number: | 5054 |
| Business Practice Address: | 12 Stillwater Ave Bangor, ME - 044013984 |
| Business Phone Number: | 2079416550 |
| Business Fax Number: | |
| Mailing Address: | 12 Stillwater Ave, BANGOR |
| State: | ME |
| Postal Code: | 044013984 |
| Phone Number: | 2079416550 |
| Fax Number: | |
| NPI Enumeration Date: | 05/27/2009 |
| NPI Last Update Date: | 05/27/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | 5054 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |