Provider Demographics
NPI:1215586227
Name:SEBASTICOOK DENTAL CENTER
Entity Type:Organization
Organization Name:SEBASTICOOK DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:NADEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-368-2500
Mailing Address - Street 1:71 ELM ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953-3121
Mailing Address - Country:US
Mailing Address - Phone:207-368-2500
Mailing Address - Fax:207-368-2501
Practice Address - Street 1:71 ELM ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953-3121
Practice Address - Country:US
Practice Address - Phone:207-368-2500
Practice Address - Fax:207-368-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty