Provider Demographics
NPI:1457933095
Name:ELEVATE DENTAL EXTRACTIONS
Entity Type:Organization
Organization Name:ELEVATE DENTAL EXTRACTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-466-0661
Mailing Address - Street 1:23 CARRIAGE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-2412
Mailing Address - Country:US
Mailing Address - Phone:207-466-0661
Mailing Address - Fax:
Practice Address - Street 1:23 CARRIAGE RD STE 2
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2412
Practice Address - Country:US
Practice Address - Phone:207-466-0661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental