Provider Demographics
NPI:1134518178
Name:LINCOLN COUNTY DENTAL, INC.
Entity Type:Organization
Organization Name:LINCOLN COUNTY DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIR/HEAD VOLUNTEER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-563-8668
Mailing Address - Street 1:748 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4683
Mailing Address - Country:US
Mailing Address - Phone:207-563-8668
Mailing Address - Fax:866-336-7756
Practice Address - Street 1:748 MAIN ST
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4683
Practice Address - Country:US
Practice Address - Phone:207-563-8668
Practice Address - Fax:866-336-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2187261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental