Provider Demographics
NPI:1164714812
Name:STANDISH DENTURE CENTER LLC
Entity Type:Organization
Organization Name:STANDISH DENTURE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LEVASSEUR
Authorized Official - Suffix:
Authorized Official - Credentials:DENTURIST
Authorized Official - Phone:207-642-2310
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084
Mailing Address - Country:US
Mailing Address - Phone:207-642-2310
Mailing Address - Fax:207-642-6815
Practice Address - Street 1:178 CAPE RD
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:ME
Practice Address - Zip Code:04084-6147
Practice Address - Country:US
Practice Address - Phone:207-642-2310
Practice Address - Fax:207-642-6815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME5010122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty