Provider Demographics
NPI:1851694996
Name:SMILE PATROL
Entity Type:Organization
Organization Name:SMILE PATROL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:WEYMOUTH
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, PHS
Authorized Official - Phone:207-717-8272
Mailing Address - Street 1:PO BOX 1386
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04441-1386
Mailing Address - Country:US
Mailing Address - Phone:207-717-8272
Mailing Address - Fax:207-997-2936
Practice Address - Street 1:2 MATHEWS ROAD
Practice Address - Street 2:
Practice Address - City:MONSON
Practice Address - State:ME
Practice Address - Zip Code:04464-0000
Practice Address - Country:US
Practice Address - Phone:207-997-2936
Practice Address - Fax:207-997-2936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2433124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME434557000OtherMAINECARE
ME1215264981OtherNPI - INDIVIDUAL