| NPI | 1407029184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY R WIETECHA Owner 207-377-6958 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ME 3627) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: ME 2556) |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2008-04-02 |