Provider Demographics
NPI:1992391536
Name:MAINELY TEETH, LLC
Entity Type:Organization
Organization Name:MAINELY TEETH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:LOMBARDI
Authorized Official - Suffix:
Authorized Official - Credentials:IPDH
Authorized Official - Phone:072-200-0592
Mailing Address - Street 1:166 REGAN LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2035
Mailing Address - Country:US
Mailing Address - Phone:207-200-0592
Mailing Address - Fax:
Practice Address - Street 1:166 REGAN LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2035
Practice Address - Country:US
Practice Address - Phone:207-808-9498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty