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NPI Code Detail

MEDICARE: GRACE ODIMAYO DMD

MEDICARE:   GRACE  ODIMAYO  DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry3705ME

General Provider Information

NPI Number : 1326081076
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE ODIMAYO DMD
Provider Business Mailing Address
First Line : 80 PARKWOOD DR
Second Line :
City : AUGUSTA
State : ME
Zip : 04330-6253
Country : US
Telephone Number : 207-621-0398
Fax Number :
Provider Business Practice Location Address
First Line : 250 ARSENAL STREET
Second Line : 11 SHS
City : AUGUSTA
State : ME
Zip : 04333-0001
Country : US
Telephone Number : 207-624-4773
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2006
Last Update Date : 07/08/2007

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Directions to “ GRACE ODIMAYO DMD” Practice Location

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