Individual
KELLY CARBONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LD
Contact information
Practice address
980 FOREST AVE STE 104, PORTLAND, ME 04103-3357
(207) 774-7645
(207) 828-5298
Mailing address
980 FOREST AVE STE 104, PORTLAND, ME 04103-3357
(207) 774-7645
(207) 828-5298
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
5024
ME
Other
Enumeration date
12/29/2009
Last updated
03/21/2013
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