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General NPI Number Information
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NPI Number | 1841691631
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Entity Type | Organization
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Legal Business Name | WHITE MOUNTAIN ORTHODONTICS, PA
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Dates
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Enumeration Date | 09/11/2014
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Last Update Date | 09/11/2014
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Provider Practice Location Address
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Address Line | 713 ROOSEVELT TRAIL
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City | NAPLES
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State | ME
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Zip | 04055
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Country | US
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Telephone | 207-894-8700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 850
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City | SCARBOROUGH
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State | ME
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Zip | 04070-0850
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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. BURTON RANKIE
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Credential | D.D.S.
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Telephone | 207-894-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DEN 4239
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License Number State | ME
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