Healthcare Provider Details

I. General information

NPI: 1306081666
Provider Name (Legal Business Name): MLH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 COMMERCE PARK
ELLSWORTH ME
04605
US

IV. Provider business mailing address

PO BOX 605
ELLSWORTH ME
04605-0605
US

V. Phone/Fax

Practice location:
  • Phone: 207-667-2770
  • Fax: 207-667-2770
Mailing address:
  • Phone: 207-667-2770
  • Fax: 207-667-2744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3679
License Number StateME

VIII. Authorized Official

Name: DR. MARC LANCE HOROWITZ
Title or Position: OWNER
Credential: DDS
Phone: 207-667-2770