Healthcare Provider Details

I. General information

NPI: 1518787498
Provider Name (Legal Business Name): MARC STROOBANTS DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 MAINE ST
POLAND ME
04274-5109
US

IV. Provider business mailing address

364 MAINE ST
POLAND ME
04274-5109
US

V. Phone/Fax

Practice location:
  • Phone: 207-998-4587
  • Fax:
Mailing address:
  • Phone: 207-998-4587
  • 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. MARC STROOBANTS
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 920-268-6716