Provider Demographics
NPI:1245619097
Name:ROSKELLEY DENTAL, PC
Entity Type:Organization
Organization Name:ROSKELLEY DENTAL, PC
Other - Org Name:BIDDEFORD SACO DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSKELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-282-9962
Mailing Address - Street 1:323 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1514
Mailing Address - Country:US
Mailing Address - Phone:207-282-9962
Mailing Address - Fax:207-283-4299
Practice Address - Street 1:323 MAIN ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1514
Practice Address - Country:US
Practice Address - Phone:207-282-9962
Practice Address - Fax:207-283-4299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME4279261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental