| NPI | 1871917179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GILLIAN R KELLY Orthodontist 207-333-2685 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 10949) |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2014-02-07 |