Individual
SHERRY M BODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LD
Contact information
Practice address
12 STILLWATER AVE, BANGOR, ME 04401-3984
(207) 941-6550
Mailing address
12 STILLWATER AVE, BANGOR, ME 04401-3984
(207) 941-6550
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
5054
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432235099
—
ME
Enumeration date
05/27/2009
Last updated
05/27/2009
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