Organization
BROADWAY DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REBEKAH K BLANCHETTE DDS (OWNER)
(207) 945-5300
Entity
Organization
Contact information
Practice address
743 BROADWAY, BANGOR, ME 04401-3225
(207) 945-5300
Mailing address
743 BROADWAY, BANGOR, ME 04401-3225
(207) 945-5300
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1679142988
1-IND
ME
01
—
1740591882
1-IND
ME
01
—
1871684282
1-IND
ME
Enumeration date
09/19/2022
Last updated
09/19/2022
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