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General NPI Number Information
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NPI Number | 1124561493
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Entity Type | Organization
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Legal Business Name | CORNISH DENTURE CENTER, LLC
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Dates
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Enumeration Date | 11/18/2016
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Last Update Date | 11/18/2016
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Provider Practice Location Address
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Address Line | 202 MAPLE ST UNIT C
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City | CORNISH
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State | ME
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Zip | 04020-3138
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Country | US
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Telephone | 207-625-9227
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Fax |
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Provider Business Mailing Address
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Address Line | 202 MAPLE ST UNIT C
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City | CORNISH
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State | ME
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Zip | 04020-3138
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Country | US
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Telephone | 207-625-9227
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | LINDA LAURETTE SOULIERE
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Credential | LD
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Telephone | 207-625-9227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number | DTR5531
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License Number State | ME
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