MEDICARE: BATH FAMILY DENTAL, LLC

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	1223G0001X	General Practice Dentistry	3775	ME

General Provider Information

NPI Number	:	1932377231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BATH FAMILY DENTAL, LLC

Provider Business Mailing Address
First Line	:	304 WASHINGTON ST
Second Line	:
City	:	BATH
State	:	ME
Zip	:	04530-1641
Country	:	US
Telephone Number	:	207-442-7581
Fax Number	:	207-442-7531

Provider Business Practice Location Address
First Line	:	304 WASHINGTON ST
Second Line	:
City	:	BATH
State	:	ME
Zip	:	04530-1641
Country	:	US
Telephone Number	:	207-442-7581
Fax Number	:	207-442-7531

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TAMMY L. COOK
Credential	:	DMD
Telephone Number	:	207-442-7581

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	02/03/2016

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Directions to “BATH FAMILY DENTAL, LLC ” Practice Location

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