| NPI | 1073040184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE A HASENFUS Dentist 207-622-1711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ME DEN4370) |
| Enumeration Date | 2017-05-19 |
| Last Update Date | 2022-07-21 |