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General NPI Number Information
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NPI Number | 1336896489
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Entity Type | Organization
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Legal Business Name | MID MAINE ORAL SURGERY
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Dates
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Enumeration Date | 03/08/2022
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Last Update Date | 03/25/2022
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Provider Practice Location Address
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Address Line | 244 KENNEDY MEMORIAL DR
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City | WATERVILLE
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State | ME
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Zip | 04901-4538
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Country | US
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Telephone | 207-873-0117
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Fax |
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Provider Business Mailing Address
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Address Line | 18 EATON DR
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City | WATERVILLE
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State | ME
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Zip | 04901-4511
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Country | US
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Telephone | 207-649-6664
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Fax |
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Authorized Official
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Title or Position | ORAL SURGEON
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Name | DR. LUKE L'HEUREUX
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Credential | DMD, MD
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Telephone | 207-649-6664
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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