Organization Name: | STANDISH DENTURE CENTER LLC |
NPI Number: | 1164714812 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PAUL MICHAEL LEVASSEUR (OWNER) |
Mailing Address: | 178 Cape Rd Standish |
State: | ME US |
Postal Code: | 040846147 |
Phone Number: | 2076422310 |
Fax Number: | 2076426815 |
NPI Enumeration Date: | 05/12/2011 |
NPI Last Update Date: | 06/02/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 122400000X |
License Number: | 5010 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Denturist |
Taxonomy Specialization: | |
Taxonomy Definition: |