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General NPI Number Information
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NPI Number | 1396974390
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Entity Type | Organization
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Legal Business Name | CLASSIC DENTURES OF MAINE
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Dates
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Enumeration Date | 07/11/2009
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Last Update Date | 07/11/2009
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Provider Practice Location Address
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Address Line | 61 HERSEY AVE
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City | BANGOR
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State | ME
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Zip | 04401-4443
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Country | US
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Telephone | 207-942-1743
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Fax |
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Provider Business Mailing Address
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Address Line | 61 HERSEY AVE
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City | BANGOR
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State | ME
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Zip | 04401-4443
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Country | US
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Telephone | 207-942-1743
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH S KINGSTON
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Credential | ED.D ; LD
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Telephone | 207-942-1743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122400000X
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Taxonomy Name | Denturist
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License Number | 5515
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License Number State | ME
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