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General NPI Number Information
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NPI Number | 1497899165
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Entity Type | Organization
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Legal Business Name | KENNEBEC VALLEY DENTAL COALITION INC
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 06/18/2020
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Provider Practice Location Address
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Address Line | 2 EVERGREEN DR
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City | OAKLAND
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State | ME
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Zip | 04963-5364
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Country | US
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Telephone | 207-861-5801
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Fax |
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Provider Business Mailing Address
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Address Line | 2 EVERGREEN DR
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City | OAKLAND
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State | ME
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Zip | 04963-5364
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Country | US
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Telephone | 207-861-5801
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. JESSICA PELOTTE
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Credential | AS, BA
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Telephone | 207-861-5801
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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 | ME
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