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General NPI Number Information
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NPI Number | 1386922565
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Entity Type | Organization
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Legal Business Name | VILLAGE SMILES
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Dates
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Enumeration Date | 07/22/2011
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Last Update Date | 07/22/2011
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Provider Practice Location Address
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Address Line | 26 MAIN ST
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City | LIMERICK
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State | ME
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Zip | 04048-3534
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Country | US
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Telephone | 207-793-8881
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Fax |
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Provider Business Mailing Address
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Address Line | 26 MAIN ST P.O. BOX 74
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City | LIMERICK
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State | ME
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Zip | 04048-3534
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Country | US
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Telephone | 207-793-8881
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Fax |
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Authorized Official
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Title or Position | INDEPENDENT DENTAL HYGIENIST
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Name | MRS. TERESA KAY CRANDALL
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Credential |
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Telephone | 207-793-8881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | PHS886
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | LAN30
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | IPH30
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License Number State | ME
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