Healthcare Provider Details

I. General information

NPI: 1902030638
Provider Name (Legal Business Name): RAYMOND T. BEDETTE, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2009
Last Update Date: 05/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WILLOW RUN 1-A
AUBURN ME
04210-8501
US

IV. Provider business mailing address

1 WILLOW RUN 1-A
AUBURN ME
04210-8501
US

V. Phone/Fax

Practice location:
  • Phone: 207-784-8587
  • Fax: 207-777-5251
Mailing address:
  • Phone: 207-784-8587
  • Fax: 207-777-5251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2797
License Number StateME

VIII. Authorized Official

Name: RAYMOND T BEDETTE
Title or Position: PRESIDENT/ORTHODONTIST
Credential: DDS
Phone: 207-784-8587