Healthcare Provider Details

I. General information

NPI: 1366574675
Provider Name (Legal Business Name): JUST FOR KIDS PEDIATRIC DENTISTRY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 US ROUTE 1
SCARBOROUGH ME
04074-9701
US

IV. Provider business mailing address

313 US ROUTE 1
SCARBOROUGH ME
04074-9701
US

V. Phone/Fax

Practice location:
  • Phone: 207-883-4203
  • Fax: 207-883-9068
Mailing address:
  • Phone: 207-883-4203
  • Fax: 207-883-9068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LORETTA MILLS
Title or Position: OFFICE MANAGER
Credential:
Phone: 207-883-4203