Provider Demographics
NPI:1437345691
Name:CHILDREN'S DENTISTRY OF SANFORD, LLP
Entity Type:Organization
Organization Name:CHILDREN'S DENTISTRY OF SANFORD, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:LUCIER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-324-0026
Mailing Address - Street 1:955 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-3574
Mailing Address - Country:US
Mailing Address - Phone:207-324-0026
Mailing Address - Fax:207-324-0013
Practice Address - Street 1:955 MAIN ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3574
Practice Address - Country:US
Practice Address - Phone:207-324-0026
Practice Address - Fax:207-324-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME38221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty