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General NPI Number Information
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NPI Number | 1720796857
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Entity Type | Organization
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Legal Business Name | MAINELY KIDS & TEENS, LLC
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Dates
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Enumeration Date | 11/08/2022
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 60 LOWELL ST
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City | RUMFORD
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State | ME
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Zip | 04276-2064
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Country | US
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Telephone | 207-974-3018
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Fax |
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Provider Business Mailing Address
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Address Line | 1 CUMBERLAND PL STE 116
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City | BANGOR
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State | ME
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Zip | 04401-5087
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Country | US
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Telephone | 207-974-3018
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Fax | 207-974-3067
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Authorized Official
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Title or Position | CEO
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Name | JEFF BATEMAN
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Credential |
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Telephone | 207-974-3018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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