Healthcare Provider Details

I. General information

NPI: 1093122848
Provider Name (Legal Business Name): ISLAND POINT DENTISTRY LLC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MAIN ST SUITE 1218
SACO ME
04072-3509
US

IV. Provider business mailing address

110 MAIN ST SUITE 1218
SACO ME
04072-3509
US

V. Phone/Fax

Practice location:
  • Phone: 207-284-4007
  • Fax: 207-284-4096
Mailing address:
  • Phone: 207-284-4007
  • Fax: 207-284-4096

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. AMANDA M ROCKWOOD
Title or Position: MANAGER
Credential: D.D.S
Phone: 207-284-4007