Healthcare Provider Details

I. General information

NPI: 1528181229
Provider Name (Legal Business Name): ISLAND COMMUNITY MEDICAL SERVICES - DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MEDICAL CENTER LOOP
VINALHAVEN ME
04863
US

IV. Provider business mailing address

PO BOX 1328
AUBURN ME
04211-1328
US

V. Phone/Fax

Practice location:
  • Phone: 207-863-4341
  • Fax:
Mailing address:
  • Phone: 207-784-9185
  • Fax: 207-784-1594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DINAH MOYER
Title or Position: DIRECTOR
Credential:
Phone: 207-863-4109