Provider Demographics
NPI:1063681534
Name:HANCOCK DENTAL, LLC
Entity Type:Organization
Organization Name:HANCOCK DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-667-8778
Mailing Address - Street 1:201 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1715
Mailing Address - Country:US
Mailing Address - Phone:207-667-8778
Mailing Address - Fax:207-667-2324
Practice Address - Street 1:201 HIGH ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1715
Practice Address - Country:US
Practice Address - Phone:207-667-8778
Practice Address - Fax:207-667-2324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3506261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental