| NPI | 1811197601 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED BOUDREAU Practice Director 207-879-0010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: ME 3810) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: ME 4027) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2013-04-01 |