Provider Demographics
NPI:1134647043
Name:QUEEN CITY DENTURES AND PARTIALS, LLC
Entity Type:Organization
Organization Name:QUEEN CITY DENTURES AND PARTIALS, LLC
Other - Org Name:LINCOLN DENTURE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/LICENSED DENTURIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:LD
Authorized Official - Phone:207-949-0860
Mailing Address - Street 1:289 WEST BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5932
Mailing Address - Country:US
Mailing Address - Phone:207-794-3300
Mailing Address - Fax:
Practice Address - Street 1:289 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04401-5932
Practice Address - Country:US
Practice Address - Phone:207-794-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME5509122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty