Healthcare Provider Details

I. General information

NPI: 1073160644
Provider Name (Legal Business Name): DR. ALDEN STANTON HURTIG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 MAIN ST
WATERVILLE ME
04901-6625
US

IV. Provider business mailing address

185 MAIN ST
WATERVILLE ME
04901-6625
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-6815
  • Fax: 207-872-6888
Mailing address:
  • Phone: 207-872-6815
  • Fax: 207-872-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN4718
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: