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General NPI Number Information
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NPI Number | 1649484098
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Entity Type | Organization
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Legal Business Name | MAIN STREET DENTAL
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 808 MAIN ST
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City | WESTBROOK
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State | ME
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Zip | 04092-3423
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Country | US
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Telephone | 207-856-6121
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Fax |
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Provider Business Mailing Address
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Address Line | 808 MAIN ST
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City | WESTBROOK
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State | ME
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Zip | 04092-3423
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Country | US
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Telephone |
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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. PAUL CLOUTIER
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Credential | DDS PA
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Telephone | 207-856-6121
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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 | 3714
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License Number State | ME
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