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General NPI Number Information
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NPI Number | 1306258371
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Entity Type | Organization
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Legal Business Name | LAKES REGION DENTAL CENTER, LLC
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Dates
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Enumeration Date | 05/27/2014
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Last Update Date | 05/27/2014
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Provider Practice Location Address
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Address Line | 6 CENTER ST
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City | OAKLAND
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State | ME
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Zip | 04963-4927
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Country | US
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Telephone | 207-624-1648
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Fax |
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Provider Business Mailing Address
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Address Line | 183 HIGHLAND AVE
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City | GARDINER
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State | ME
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Zip | 04345-1888
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. REBECCA JEAN BERRY
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Credential | DMD
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Telephone | 207-624-1648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 4188
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License Number State | ME
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