Organization
RANDAL JOSEPH THIVIERGE
Active
Other names
MidCoast Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JODY L LAVOIE (OPERATIONS MANAGER)
(207) 236-3100
Entity
Organization
Contact information
Practice address
625 ROCKLAND ST, ROCKPORT, ME 04856-5320
(207) 236-3100
(207) 236-8380
Mailing address
625 ROCKLAND ST, ROCKPORT, ME 04856-5320
(207) 236-3100
(207) 236-8380
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3037
ME
332BC3200X
Customized Equipment (DME)
3037
ME
Other
Enumeration date
03/24/2011
Last updated
11/01/2011
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