Healthcare Provider Details

I. General information

NPI: 1326274051
Provider Name (Legal Business Name): TOOTH PROTECTORS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WESTMINSTER ST
LEWISTON ME
04240-3531
US

IV. Provider business mailing address

21 WESTMINSTER ST
LEWISTON ME
04240-3531
US

V. Phone/Fax

Practice location:
  • Phone: 207-513-1111
  • Fax: 207-513-1197
Mailing address:
  • Phone: 207-513-1111
  • Fax: 207-513-1197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number StateME

VIII. Authorized Official

Name: MRS. AMANDA RAY
Title or Position: PRACTICE ADMIN
Credential:
Phone: 207-513-1111