Provider Demographics
NPI:1841011335
Name:AMERICAN HERITAGE DENTISTRY, PLLC
Entity type:Organization
Organization Name:AMERICAN HERITAGE DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LIBBY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-671-3032
Mailing Address - Street 1:35 DENNETT RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9611
Mailing Address - Country:US
Mailing Address - Phone:207-671-3032
Mailing Address - Fax:
Practice Address - Street 1:163 HOLLIS RD
Practice Address - Street 2:
Practice Address - City:HOLLIS CENTER
Practice Address - State:ME
Practice Address - Zip Code:04042-4002
Practice Address - Country:US
Practice Address - Phone:207-929-3550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental