Organization
COSMETIC & GENERAL DENTISTRY OF WINTHROP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAY R WIETECHA DMD (OWNER)
(207) 377-6958
Entity
Organization
Contact information
Practice address
28 OLD WESTERN AVE, WINTHROP, ME 04364-4060
(207) 377-6958
(207) 377-4349
Mailing address
28 OLD WESTERN AVE, WINTHROP, ME 04364-4060
(207) 377-6958
(207) 377-4349
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
2556
ME
261QD0000X
Dental Clinic/Center
Primary
3627
ME
Other
Enumeration date
04/02/2008
Last updated
04/02/2008
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