=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275418261
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SACO BAY DENTAL WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2025
-----------------------------------------------------
Last Update Date | 08/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 238 NORTH ST
-----------------------------------------------------
City | SACO
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04072-1870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-503-0003
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 CYR RD
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03561-3704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-366-6132
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTAL HYGIENIST/OWNER
-----------------------------------------------------
Name | KATIE ELIZABETH LATULIP
-----------------------------------------------------
Credential | RDH, IPDH
-----------------------------------------------------
Telephone | 207-503-0003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------