Healthcare Provider Details

I. General information

NPI: 1952198632
Provider Name (Legal Business Name): MAINE DENTAL SURGERY CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 US ROUTE 1 STE 3A
YARMOUTH ME
04096-7006
US

IV. Provider business mailing address

701 US ROUTE 1 STE 3A
YARMOUTH ME
04096-7006
US

V. Phone/Fax

Practice location:
  • Phone: 207-740-8105
  • Fax:
Mailing address:
  • Phone: 207-740-8105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATE LYDON
Title or Position: CLINICAL DIRECTOR
Credential: RN
Phone: 207-740-8105