Provider Demographics
NPI:1376041590
Name:DOVER AUDIOLOGY, P.A.
Entity Type:Organization
Organization Name:DOVER AUDIOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNVER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CLUKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-A
Authorized Official - Phone:207-564-3337
Mailing Address - Street 1:859 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1020
Mailing Address - Country:US
Mailing Address - Phone:207-564-3337
Mailing Address - Fax:
Practice Address - Street 1:859 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1020
Practice Address - Country:US
Practice Address - Phone:207-564-3337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP1360237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty