Provider Demographics
NPI:1497980650
Name:YORK FAMILY DENTAL
Entity Type:Organization
Organization Name:YORK FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ELIANE
Authorized Official - Last Name:VIZENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-363-7102
Mailing Address - Street 1:433F US ROUTE 1
Mailing Address - Street 2:COTTAGE PLACE SUITE 107
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909
Mailing Address - Country:US
Mailing Address - Phone:207-363-7102
Mailing Address - Fax:
Practice Address - Street 1:433F US ROUTE 1
Practice Address - Street 2:COTTAGE PLACE SUITE 107
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909
Practice Address - Country:US
Practice Address - Phone:207-363-7102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDN40941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty