Healthcare Provider Details

I. General information

NPI: 1447268073
Provider Name (Legal Business Name): ASSOCIATES IN ORTHODONTICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 STILLWATER AVE
BANGOR ME
04401-3616
US

IV. Provider business mailing address

PO BOX 920
BANGOR ME
04402-0920
US

V. Phone/Fax

Practice location:
  • Phone: 207-942-1442
  • Fax: 297-942-1832
Mailing address:
  • Phone: 207-942-1442
  • Fax: 207-942-1832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LOUIS J HARDY
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 207-942-1442