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General NPI Number Information
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NPI Number | 1134032410
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Entity Type | Organization
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Legal Business Name | WOODLAND DENTAL AESTHETICS PLLC
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Dates
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Enumeration Date | 09/25/2026
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Last Update Date | 09/25/2026
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Provider Practice Location Address
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Address Line | 1389 BRIDGTON RD STE 2
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City | WESTBROOK
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State | ME
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Zip | 04092-2573
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Country | US
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Telephone | 207-464-2600
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Fax | 207-464-2800
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Provider Business Mailing Address
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Address Line | 205 PINECREST RD
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City | PORTLAND
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State | ME
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Zip | 04102-1225
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Country | US
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Telephone | 207-464-2600
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Fax | 207-464-2800
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. IVAN SOBERANES
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Credential | DMD
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Telephone | 207-464-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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