Provider Demographics
NPI:1205378569
Name:DANDY DENTURES, LLC
Entity Type:Organization
Organization Name:DANDY DENTURES, LLC
Other - Org Name:CENTRAL MAINE DENTURE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LD
Authorized Official - Phone:207-877-9917
Mailing Address - Street 1:3 BRIGHAM ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5114
Mailing Address - Country:US
Mailing Address - Phone:207-877-9917
Mailing Address - Fax:
Practice Address - Street 1:3 BRIGHAM ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5114
Practice Address - Country:US
Practice Address - Phone:207-877-9917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME5512122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty