Healthcare Provider Details

I. General information

NPI: 1174229959
Provider Name (Legal Business Name): ARUNDEL FAMILY DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 PORTLAND RD
ARUNDEL ME
04046-8104
US

IV. Provider business mailing address

1220 PORTLAND RD
ARUNDEL ME
04046-8104
US

V. Phone/Fax

Practice location:
  • Phone: 207-985-3576
  • Fax:
Mailing address:
  • Phone: 207-985-3576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DAVID LEE
Title or Position: COO
Credential:
Phone: 732-207-1689