Provider Demographics
NPI:1366694242
Name:MDI DENTAL ARTS, P.C.
Entity Type:Organization
Organization Name:MDI DENTAL ARTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-288-4794
Mailing Address - Street 1:67 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-1834
Mailing Address - Country:US
Mailing Address - Phone:207-288-4794
Mailing Address - Fax:
Practice Address - Street 1:67 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-1834
Practice Address - Country:US
Practice Address - Phone:207-288-4794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4058122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty