Organization
WATERBORO DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VALERIE LARIVIERE (OWNER)
(207) 247-3511
Entity
Organization
Contact information
Practice address
813B MAIN ST, WATERBORO, ME 04087-3084
(207) 247-3511
Mailing address
PO BOX 378, WATERBORO, ME 04087-0378
(207) 247-3511
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DEN4703
DENTAL LICENSE
ME
01
—
ME2821
DENTAL LICENSE
ME
Enumeration date
08/24/2023
Last updated
08/24/2023
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