Provider Demographics
NPI:1467225466
Name:ADS DENTURE TECHNOLOGIES
Entity Type:Organization
Organization Name:ADS DENTURE TECHNOLOGIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SOUCY
Authorized Official - Suffix:
Authorized Official - Credentials:LD
Authorized Official - Phone:207-794-5322
Mailing Address - Street 1:57 NOWELL ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03906-6519
Mailing Address - Country:US
Mailing Address - Phone:207-794-5322
Mailing Address - Fax:
Practice Address - Street 1:980 FOREST AVE STE 104
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3357
Practice Address - Country:US
Practice Address - Phone:207-774-7645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty