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General NPI Number Information
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NPI Number | 1750501318
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Entity Type | Organization
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Legal Business Name | NEW ENGLAND DENTURE CENTER
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12 STILLWATER AVE
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City | BANGOR
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State | ME
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Zip | 04401-3984
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Country | US
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Telephone | 207-941-6550
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Fax | 207-973-3952
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Provider Business Mailing Address
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Address Line | 12 STILLWATER AVE
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City | BANGOR
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State | ME
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Zip | 04401-3984
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Country | US
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Telephone | 207-941-6550
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Fax | 207-973-3952
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILLIAM F BUXTON JR.
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Credential | L.D.
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Telephone | 207-941-6550
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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 | 5004
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License Number State | ME
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