| NPI | 1649580853 |
|---|---|
| Doing Business As | JETPORT DENTURE CENTER |
| Entity Type | Organization |
| Authorized Contact | KELLY CARBONE RICHARDSON President 207-893-1346 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ME 5024) |
| Enumeration Date | 2010-10-21 |
| Last Update Date | 2010-10-21 |