Provider Demographics
NPI:1336648633
Name:QUINTESSENCE, LLC
Entity Type:Organization
Organization Name:QUINTESSENCE, LLC
Other - Org Name:BUCKSPORT DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ATWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-469-2912
Mailing Address - Street 1:PO BOX 1898
Mailing Address - Street 2:
Mailing Address - City:BUCKSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04416-1898
Mailing Address - Country:US
Mailing Address - Phone:207-469-2912
Mailing Address - Fax:
Practice Address - Street 1:154 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUCKSPORT
Practice Address - State:ME
Practice Address - Zip Code:04416
Practice Address - Country:US
Practice Address - Phone:207-469-2912
Practice Address - Fax:207-469-2912
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUCKSPORT DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4420261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental