Healthcare Provider Details

I. General information

NPI: 1740104868
Provider Name (Legal Business Name): SOUTHERN MAINE DENTURES AND IMPLANTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL CENTER DR
BIDDEFORD ME
04005-9400
US

IV. Provider business mailing address

2 MEDICAL CENTER DR
BIDDEFORD ME
04005-9400
US

V. Phone/Fax

Practice location:
  • Phone: 207-413-2023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAYLA KRAWCZYNSKI
Title or Position: ATTORNEY
Credential:
Phone: 314-949-5201