Organization
MAINE CENTER FOR DENTAL MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMED MANSOORUL IMAM D.D.S. (PRESIDENT/DENTIST)
(207) 474-9503
Entity
Organization
Contact information
Practice address
59 PLEASANT ST, SKOWHEGAN, ME 04976-1227
(207) 474-9503
(207) 474-5271
Mailing address
59 PLEASANT ST, SKOWHEGAN, ME 04976-1227
(207) 474-9503
(207) 474-5271
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DEN4231
ME
Other
Enumeration date
11/15/2012
Last updated
11/15/2015
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