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General NPI Number Information
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NPI Number | 1639386576
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Entity Type | Organization
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Legal Business Name | MID-MAINE DENTAL CENTER, P A
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 09/18/2009
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Provider Practice Location Address
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Address Line | 334 AUGUSTA RD
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City | WINSLOW
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State | ME
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Zip | 04901-7167
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Country | US
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Telephone | 207-873-9600
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Fax | 207-873-5629
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Provider Business Mailing Address
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Address Line | 334 AUGUSTA RD
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City | WINSLOW
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State | ME
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Zip | 04901-7167
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Country | US
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Telephone | 207-873-9600
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Fax | 207-873-5629
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Authorized Official
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Title or Position | DENTIST
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Name | DR. STEVEN CHARLES KLASSON
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Credential | DMD
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Telephone | 207-873-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3541
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License Number State | ME
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