Provider Demographics
NPI:1770025694
Name:DEN DENT AL. LLC
Entity Type:Organization
Organization Name:DEN DENT AL. LLC
Other - Org Name:NEW ENGLAND DENTAL AND DENTURE OF AUGUSTA
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:NADEAU ALDILAIMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-621-2904
Mailing Address - Street 1:8 SHUMAN AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7751
Mailing Address - Country:US
Mailing Address - Phone:207-621-2904
Mailing Address - Fax:207-623-0396
Practice Address - Street 1:8 SHUMAN AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7751
Practice Address - Country:US
Practice Address - Phone:207-621-2904
Practice Address - Fax:207-623-0396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty