Provider Demographics
NPI:1497899165
Name:KENNEBEC VALLEY DENTAL COALITION INC
Entity Type:Organization
Organization Name:KENNEBEC VALLEY DENTAL COALITION INC
Other - Org Name:COMMUNITY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:AS, BA
Authorized Official - Phone:207-861-5801
Mailing Address - Street 1:2 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04963-5364
Mailing Address - Country:US
Mailing Address - Phone:207-861-5801
Mailing Address - Fax:
Practice Address - Street 1:2 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:ME
Practice Address - Zip Code:04963-5364
Practice Address - Country:US
Practice Address - Phone:207-861-5801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental