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NPI Code Detail

MEDICARE: CORNISH DENTURE CENTER, LLC

MEDICARE: CORNISH DENTURE CENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1292200000XDental LaboratoryDTR5531ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DTR5531OTHERME122400000X

General Provider Information

NPI Number : 1124561493
Entity Type Code : Organization
Provider Name (Legal Business Name) : CORNISH DENTURE CENTER, LLC
Provider Business Mailing Address
First Line : 202 MAPLE ST UNIT C
Second Line :
City : CORNISH
State : ME
Zip : 04020-3138
Country : US
Telephone Number : 207-625-9227
Fax Number :
Provider Business Practice Location Address
First Line : 202 MAPLE ST UNIT C
Second Line :
City : CORNISH
State : ME
Zip : 04020-3138
Country : US
Telephone Number : 207-625-9227
Fax Number :
Authorized Official
Title or Position : OWNER/OPERATOR
Name : LINDA LAURETTE SOULIERE
Credential : LD
Telephone Number : 207-625-9227
Provider Enumeration Date : 11/18/2016
Last Update Date : 11/18/2016

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Directions to “CORNISH DENTURE CENTER, LLC ” Practice Location

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