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General NPI Number Information
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NPI Number | 1346687621
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Entity Type | Organization
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Legal Business Name | SMILE DESIGN ELLSWORTH, PC
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Dates
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Enumeration Date | 05/28/2013
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 382 STATE ST
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City | ELLSWORTH
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State | ME
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Zip | 04605-3330
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Country | US
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Telephone | 207-664-2474
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Fax | 207-667-1539
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Provider Business Mailing Address
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Address Line | PO BOX 611
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City | ELLSWORTH
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State | ME
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Zip | 04605-0611
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Country | US
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Telephone | 207-664-2474
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Fax | 207-667-1539
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Authorized Official
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Title or Position | DENTIST/CEO
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Name | DR. AARON JAMES PALMER SR.
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Credential | D.M.D.
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Telephone | 207-664-2474
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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 | DEN4082
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License Number State | ME
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