Provider Demographics
NPI:1649048976
Name:MIDCOAST DENTAL HEALTH LLC
Entity type:Organization
Organization Name:MIDCOAST DENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER-BISSON
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:207-576-2096
Mailing Address - Street 1:331 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-7255
Mailing Address - Country:US
Mailing Address - Phone:207-576-2096
Mailing Address - Fax:
Practice Address - Street 1:331 MAINE ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3358
Practice Address - Country:US
Practice Address - Phone:207-576-2096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty