Healthcare Provider Details

I. General information

NPI: 1356550834
Provider Name (Legal Business Name): MR. PHILIP SANGUEDOLCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 ROUTE 236 SUITE 215
KITTERY ME
03904-6000
US

IV. Provider business mailing address

37 ROUTE 236 SUITE 215
KITTERY ME
03904-6000
US

V. Phone/Fax

Practice location:
  • Phone: 207-451-9898
  • Fax: 207-438-0257
Mailing address:
  • Phone: 207-451-9898
  • Fax: 207-438-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number5023
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: