Provider Demographics
NPI:1598130619
Name:STANDISH FAMILY DENTAL HEALTH
Entity Type:Organization
Organization Name:STANDISH FAMILY DENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-642-4300
Mailing Address - Street 1:PO BOX 1370
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084-1370
Mailing Address - Country:US
Mailing Address - Phone:207-642-4300
Mailing Address - Fax:
Practice Address - Street 1:43 OSSIPEE TRL E
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:ME
Practice Address - Zip Code:04084-6404
Practice Address - Country:US
Practice Address - Phone:207-642-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN 4378122300000X
MEDEN 4377122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty