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Organization
MDG DENTAL ELLSWORTH PA LLC
Active
Organization
MDG DENTAL ELLSWORTH PA LLC
Active
Other names
Blue Hill Peninsula Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL D GILLINS DMD, FACP, DABP (OWNER)
(207) 374-5398
Entity
Organization
Contact information
Practice address
292 SOUTH ST, BLUE HILL, ME 04614-6122
(207) 374-5398
Mailing address
PO BOX 6158, BLUE HILL, ME 04614-6158
(207) 374-5398
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528323102
—
WI
Enumeration date
12/01/2020
Last updated
03/07/2025
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