Healthcare Provider Details

I. General information

NPI: 1134518178
Provider Name (Legal Business Name): LINCOLN COUNTY DENTAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 MAIN ST
DAMARISCOTTA ME
04543-4683
US

IV. Provider business mailing address

748 MAIN ST
DAMARISCOTTA ME
04543-4683
US

V. Phone/Fax

Practice location:
  • Phone: 207-563-8668
  • Fax: 866-336-7756
Mailing address:
  • Phone: 207-563-8668
  • Fax: 866-336-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number2187
License Number StateME

VIII. Authorized Official

Name: DR. JAMES G. OLSON
Title or Position: BOARD CHAIR/HEAD VOLUNTEER
Credential: D.D.S.
Phone: 207-563-8668