Healthcare Provider Details

I. General information

NPI: 1841011335
Provider Name (Legal Business Name): AMERICAN HERITAGE DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 HOLLIS RD
HOLLIS CENTER ME
04042-4002
US

IV. Provider business mailing address

35 DENNETT RD
DAYTON ME
04005-9611
US

V. Phone/Fax

Practice location:
  • Phone: 207-929-3550
  • Fax:
Mailing address:
  • Phone: 207-671-3032
  • 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. LUKE RICHARD LIBBY
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 207-671-3032