Provider Demographics
NPI:1346687621
Name:SMILE DESIGN ELLSWORTH, PC
Entity Type:Organization
Organization Name:SMILE DESIGN ELLSWORTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:SR
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-664-2474
Mailing Address - Street 1:PO BOX 611
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-0611
Mailing Address - Country:US
Mailing Address - Phone:207-664-2474
Mailing Address - Fax:207-667-1539
Practice Address - Street 1:382 STATE ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-3330
Practice Address - Country:US
Practice Address - Phone:207-664-2474
Practice Address - Fax:207-667-1539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4082261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental