Provider Demographics
NPI:1518064047
Name:MOUNT DESERT ISLAND HOSPITAL
Entity Type:Organization
Organization Name:MOUNT DESERT ISLAND HOSPITAL
Other - Org Name:COMMUNITY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MEDICAL STAFF SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-288-5081
Mailing Address - Street 1:10 WAYMAN LN
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-1625
Mailing Address - Country:US
Mailing Address - Phone:207-288-5082
Mailing Address - Fax:207-288-8620
Practice Address - Street 1:4 COMMUNITY LANE
Practice Address - Street 2:
Practice Address - City:SOUTHWEST HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04679-4273
Practice Address - Country:US
Practice Address - Phone:207-244-2888
Practice Address - Fax:207-244-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
ME1347980001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1347980001OtherDME SUPPLIER
ME1347980001OtherDME SUPPLIER