Provider Demographics
NPI:1710369285
Name:BETHEL FAMILY DENTISTRY
Entity Type:Organization
Organization Name:BETHEL FAMILY DENTISTRY
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PASTOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-824-3378
Mailing Address - Street 1:13 BRACKETT ST
Mailing Address - Street 2:
Mailing Address - City:DIXFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04224-9579
Mailing Address - Country:US
Mailing Address - Phone:207-418-7387
Mailing Address - Fax:207-824-3012
Practice Address - Street 1:44 NORTH RD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:ME
Practice Address - Zip Code:04217-4421
Practice Address - Country:US
Practice Address - Phone:207-824-3378
Practice Address - Fax:207-824-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4431261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental