Healthcare Provider Details

I. General information

NPI: 1750501318
Provider Name (Legal Business Name): NEW ENGLAND DENTURE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 STILLWATER AVE
BANGOR ME
04401-3984
US

IV. Provider business mailing address

12 STILLWATER AVE
BANGOR ME
04401-3984
US

V. Phone/Fax

Practice location:
  • Phone: 207-941-6550
  • Fax: 207-973-3952
Mailing address:
  • Phone: 207-941-6550
  • Fax: 207-973-3952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number5004
License Number StateME

VIII. Authorized Official

Name: MR. WILLIAM F BUXTON JR.
Title or Position: PRESIDENT
Credential: L.D.
Phone: 207-941-6550