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General NPI Number Information
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NPI Number | 1134168073
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Entity Type | Organization
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Legal Business Name | ATLANTIC DENTAL ASSOCIATES
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1060 US ROUTE 1
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City | YORK
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State | ME
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Zip | 03909-5821
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Country | US
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Telephone | 207-363-2406
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Fax | 207-363-6037
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Provider Business Mailing Address
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Address Line | PO BOX 323
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City | YORK
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State | ME
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Zip | 03909-0323
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Country | US
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Telephone | 207-363-2406
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Fax | 207-363-6037
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MARIE MARVIN
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Credential |
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Telephone | 207-363-2406
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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 | 2976
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License Number State | ME
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