Organization
ACADEMY DENTAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDI BOUCHARD DO (OFFICE/BUSINESS MANAGER)
(207) 764-3764
Entity
Organization
Contact information
Practice address
179 ACEDEMY ST, PRESQUE ISLE, ME 04769
(207) 764-3764
(207) 764-3367
Mailing address
179 ACEDEMY ST, PRESQUE ISLE, ME 04769
(207) 764-3764
(207) 764-3367
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129220000
—
ME
Enumeration date
08/04/2006
Last updated
10/02/2018
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