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General NPI Number Information
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NPI Number | 1134226277
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Entity Type | Organization
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Legal Business Name | CAMDEN HILLS DENTAL CARE LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10 GRANITE WAY 200 WEST PROFESSIONAL OFFICES
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City | ROCKPORT
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State | ME
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Zip | 04856
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Country | US
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Telephone | 207-236-2400
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Fax | 207-236-2598
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Provider Business Mailing Address
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Address Line | 10 GRANITE WAY 200 WEST PROFESSIONAL OFFICES
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City | ROCKPORT
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State | ME
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Zip | 04856
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Country | US
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Telephone | 207-236-2400
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Fax | 207-236-2598
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Authorized Official
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Title or Position | SOLE MEMBER LLC
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Name | DR. JONATHAN M GOSS
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Credential | DDS
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Telephone | 207-236-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2970
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License Number State | ME
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