| NPI | 1245619097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB ROSKELLEY Owner/Dentist 207-282-9962 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: ME 4279) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2015-05-27 |