Provider Demographics
NPI:1952721276
Name:CENTRAL MAINE DENTAL, L.L.C.
Entity Type:Organization
Organization Name:CENTRAL MAINE DENTAL, L.L.C.
Other - Org Name:ANDROSCOGGIN DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-783-8800
Mailing Address - Street 1:488 SABATTUS ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-4113
Mailing Address - Country:US
Mailing Address - Phone:207-783-8800
Mailing Address - Fax:207-783-6968
Practice Address - Street 1:488 SABATTUS ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-4113
Practice Address - Country:US
Practice Address - Phone:207-783-8800
Practice Address - Fax:207-783-6968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN43511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty