Provider Demographics
NPI:1184168684
Name:MIDCOAST DENTURE DESIGN
Entity type:Organization
Organization Name:MIDCOAST DENTURE DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:APRIL
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LD
Authorized Official - Phone:207-567-3032
Mailing Address - Street 1:477 N SEARSPORT RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:ME
Mailing Address - Zip Code:04981-3401
Mailing Address - Country:US
Mailing Address - Phone:207-567-3032
Mailing Address - Fax:
Practice Address - Street 1:477 N SEARSPORT RD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:ME
Practice Address - Zip Code:04981-3401
Practice Address - Country:US
Practice Address - Phone:207-567-3032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDTR5530122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty