Healthcare Provider Details

I. General information

NPI: 1124505581
Provider Name (Legal Business Name): NORTEY DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 POST RD STE 1A
WELLS ME
04090-4562
US

IV. Provider business mailing address

1332 POST RD STE 1A
WELLS ME
04090-4562
US

V. Phone/Fax

Practice location:
  • Phone: 207-646-5297
  • Fax:
Mailing address:
  • Phone: 207-646-5297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN4340
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. NII NORTE LOKKO
Title or Position: OWNER
Credential: DMD
Phone: 76-465-2972