Organization
MAINE TINY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLI DESOUZA IPDH,RDH,CDA (INDEPENDENT DENTAL HYGIENIST)
(207) 500-1525
Entity
Organization
Contact information
Practice address
303 KIMBALL POND RD, NEW SHARON, ME 04955-3703
(207) 500-1525
Mailing address
303 KIMBALL POND RD, NEW SHARON, ME 04955-3703
(207) 500-1525
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
—
—
Other
Enumeration date
05/13/2024
Last updated
05/13/2024
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