Provider Demographics
NPI:1366867517
Name:GREATER LINCOLN SLEEP CENTER
Entity Type:Organization
Organization Name:GREATER LINCOLN SLEEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DURWIN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LIBBY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-794-6144
Mailing Address - Street 1:224 ENFIELD RD
Mailing Address - Street 2:PO BOX 335
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-1184
Mailing Address - Country:US
Mailing Address - Phone:207-794-6144
Mailing Address - Fax:207-794-6135
Practice Address - Street 1:224 ENFIELD RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-1184
Practice Address - Country:US
Practice Address - Phone:207-794-6144
Practice Address - Fax:207-794-6135
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DURWIN Y LIBBY DMD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-25
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3342332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME7517360001Medicare NSC