Organization
HIGH TIDE DENTAL, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUCAS HOMICZ (MANAGER)
(207) 767-3211
Entity
Organization
Contact information
Practice address
176 OCEAN HOUSE RD, CAPE ELIZABETH, ME 04107-1172
(207) 767-3211
(207) 767-3451
Mailing address
176 OCEAN HOUSE RD, CAPE ELIZABETH, ME 04107-1172
(207) 767-3211
(207) 767-3451
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4237
ME
Other
Enumeration date
11/17/2015
Last updated
11/17/2015
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