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Organization

SOUTHERN MAINE PEDIATRIC DENTISTRY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. WHITNEY RALSTON WIGNALL DMD (PEDIATRIC DENTIST)
(207) 773-3111
Entity
Organization

Contact information

Practice address
75 JOHN ROBERTS RD, SUIT 10B, SOUTH PORTLAND, ME 04106-6914
(207) 773-3111
Mailing address
75 JOHN ROBERTS RD, SUIT 10B, SOUTH PORTLAND, ME 04106-6914
(207) 773-3111

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
3767
ME

Other

Enumeration date
07/31/2007
Last updated
07/31/2007
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