Healthcare Provider Details

I. General information

NPI: 1043018831
Provider Name (Legal Business Name): KATAHDIN SMILES DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SPRUCE ST
EAST MILLINOCKET ME
04430-1161
US

IV. Provider business mailing address

1 SPRUCE ST
EAST MILLINOCKET ME
04430-1161
US

V. Phone/Fax

Practice location:
  • Phone: 207-746-9353
  • Fax:
Mailing address:
  • Phone: 207-746-9353
  • 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: KRISTEN R SCIOLINO
Title or Position: OWNER
Credential: DMD
Phone: 207-794-6896