MEDICARE: BETHEL FAMILY DENTISTRY PC

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
1	261QD0000X	Dental Clinic/Center	DEN4520	ME

General Provider Information

NPI Number	:	1891228284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHEL FAMILY DENTISTRY PC

Provider Business Mailing Address
First Line	:	44 NORTH RD
Second Line	:
City	:	BETHEL
State	:	ME
Zip	:	04217-4421
Country	:	US
Telephone Number	:	207-824-3378
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 NORTH RD
Second Line	:
City	:	BETHEL
State	:	ME
Zip	:	04217-4421
Country	:	US
Telephone Number	:	207-824-3378
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	DR. JAN SAPAK
Credential	:	DMD
Telephone Number	:	207-824-3378

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	04/04/2017

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