Provider Demographics
NPI:1003241654
Name:HERMON FAMILY DENTAL, PA
Entity Type:Organization
Organization Name:HERMON FAMILY DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-848-2555
Mailing Address - Street 1:2402 ROUTE 2
Mailing Address - Street 2:SUITE E
Mailing Address - City:HERMON
Mailing Address - State:ME
Mailing Address - Zip Code:04401-0665
Mailing Address - Country:US
Mailing Address - Phone:207-848-2555
Mailing Address - Fax:207-848-9012
Practice Address - Street 1:2402 ROUTE 2
Practice Address - Street 2:SUITE E
Practice Address - City:HERMON
Practice Address - State:ME
Practice Address - Zip Code:04401-0665
Practice Address - Country:US
Practice Address - Phone:207-848-2555
Practice Address - Fax:207-848-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME4141261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental