Provider Demographics
NPI:1225429657
Name:SWEET DENTAL, PA
Entity Type:Organization
Organization Name:SWEET DENTAL, PA
Other - Org Name:COMPREHENSIVE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEET
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-577-6732
Mailing Address - Street 1:107 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-8804
Mailing Address - Country:US
Mailing Address - Phone:207-577-6732
Mailing Address - Fax:
Practice Address - Street 1:306 US ROUTE 1 BLDG B
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7640
Practice Address - Country:US
Practice Address - Phone:207-396-4373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4170122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty