| NPI | 1558605642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOHAMMED MANSOORUL IMAM President/Dentist 207-474-9503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ME DEN4231) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2015-11-15 |