| NPI | 1205039773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA LYNN LIBBY Secretary 207-873-5511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ME 2002506) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2008-05-29 |