Healthcare Provider Details

I. General information

NPI: 1912640608
Provider Name (Legal Business Name): MILL BRIDGE DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 MARKET ST
FORT KENT ME
04743-1520
US

IV. Provider business mailing address

271 MARKET ST
FORT KENT ME
04743-1520
US

V. Phone/Fax

Practice location:
  • Phone: 207-834-3907
  • 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: DR. BRANDON POWELL RINKER
Title or Position: DENTIST
Credential: DDS
Phone: 702-480-9009