# CORNISH DENTURE CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124561493
- **Authorized official:** LINDA LAURETTE SOULIERE LD (OWNER/OPERATOR)
- **Authorized official phone:** (207) 625-9227

## Contact information

- **Practice address:** 202 MAPLE ST UNIT C, CORNISH, ME 04020-3138
- **Practice address phone:** (207) 625-9227
- **Mailing address:** 202 MAPLE ST UNIT C, CORNISH, ME 04020-3138
- **Mailing address phone:** (207) 625-9227

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 292200000X | Dental Laboratory | DTR5531 | ME | Yes |

## Other

- **Enumeration date:** 11/18/2016
- **Last updated:** 11/18/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | DTR5531 | 122400000X | ME |