Provider Demographics
NPI:1841581873
Name:DENTURE CRAFTERS LLC.
Entity Type:Organization
Organization Name:DENTURE CRAFTERS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:SANGUEDOLCE
Authorized Official - Suffix:
Authorized Official - Credentials:LD
Authorized Official - Phone:207-361-4485
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-2000
Mailing Address - Country:US
Mailing Address - Phone:207-361-4485
Mailing Address - Fax:
Practice Address - Street 1:647 US ROUTE 1 STE 107
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1689
Practice Address - Country:US
Practice Address - Phone:207-361-4485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME5023122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty