Healthcare Provider Details

I. General information

NPI: 1487420410
Provider Name (Legal Business Name): SKOWHEGAN FAMILY DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 S FACTORY ST
SKOWHEGAN ME
04976-1425
US

IV. Provider business mailing address

28 S FACTORY ST
SKOWHEGAN ME
04976-1425
US

V. Phone/Fax

Practice location:
  • Phone: 207-474-9326
  • Fax:
Mailing address:
  • Phone: 207-474-9326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. LUKE KLINKER
Title or Position: OWNER
Credential: DMD
Phone: 972-632-9238