Provider Demographics
NPI:1235553413
Name:MOUNT DESERT ISLAND HOSPITAL
Entity Type:Organization
Organization Name:MOUNT DESERT ISLAND HOSPITAL
Other - Org Name:COMMUNITY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR. MEDICAL STAFF SUPPORT & QUALIT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT
Authorized Official - Phone:207-288-5081
Mailing Address - Street 1:PO BOX 731
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04679-0731
Mailing Address - Country:US
Mailing Address - Phone:207-244-2888
Mailing Address - Fax:
Practice Address - Street 1:4 COMMUNITY LANE
Practice Address - Street 2:
Practice Address - City:SOUTHWEST HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04679
Practice Address - Country:US
Practice Address - Phone:207-244-2888
Practice Address - Fax:207-244-0490
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT DESERT ISLAND HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-10
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental