Provider Demographics
NPI:1821709353
Name:BANGOR DENTURE
Entity Type:Organization
Organization Name:BANGOR DENTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTURIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPAULDING
Authorized Official - Suffix:
Authorized Official - Credentials:LD
Authorized Official - Phone:207-573-4242
Mailing Address - Street 1:753 STILLWATER AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3633
Mailing Address - Country:US
Mailing Address - Phone:207-573-4242
Mailing Address - Fax:
Practice Address - Street 1:753 STILLWATER AVE STE 6
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3633
Practice Address - Country:US
Practice Address - Phone:207-573-4242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty