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General NPI Number Information
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NPI Number | 1760204291
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Entity Type | Organization
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Legal Business Name | MAKEMESMILE
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 242 MAIN ST
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City | YARMOUTH
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State | ME
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Zip | 04096-6714
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Country | US
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Telephone | 207-847-0176
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Fax |
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Provider Business Mailing Address
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Address Line | 242 MAIN ST
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City | YARMOUTH
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State | ME
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Zip | 04096-6714
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Country | US
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Telephone | 207-847-0176
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. ANTHONY RUSSO
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Credential | DDS
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Telephone | 917-796-8612
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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 |
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License Number State |
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