Provider Demographics
NPI:1770179970
Name:SEASIDE MAINE DENTISTRY
Entity Type:Organization
Organization Name:SEASIDE MAINE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILA
Authorized Official - Middle Name:
Authorized Official - Last Name:I
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-569-8167
Mailing Address - Street 1:413 ALFRED ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3742
Mailing Address - Country:US
Mailing Address - Phone:207-569-8167
Mailing Address - Fax:
Practice Address - Street 1:413 ALFRED ST STE 101
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3742
Practice Address - Country:US
Practice Address - Phone:207-490-7030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-12
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental