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Organization
INDEPENDENT DENTURE CENTER PC
Active
Organization
INDEPENDENT DENTURE CENTER PC
Active
Other names
Jetport Denture Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KELLY CARBONE RICHARDSON LD (PRESIDENT)
(207) 893-1346
Entity
Organization
Contact information
Practice address
530 ROOSEVELT TRL, WINDHAM, ME 04062-4901
(207) 893-1346
(207) 893-0114
Mailing address
PO BOX 1018, WINDHAM, ME 04062-1018
(207) 893-1346
(207) 893-0114
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
5024
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
433189000
—
ME
Enumeration date
10/21/2010
Last updated
10/21/2010
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