Organization
DENTAL SPECIALISTS OF MAINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS JARED BOUDREAU MBA, MSA (PRACTICE DIRECTOR)
(207) 879-0010
Entity
Organization
Contact information
Practice address
1355 CONGRESS ST STE A, PORTLAND, ME 04102-2137
(207) 879-0010
(207) 879-0011
Mailing address
1355 CONGRESS ST STE A, PORTLAND, ME 04102-2137
(207) 879-0010
(207) 879-0011
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
3810
ME
1223E0200X
Endodontics
4027
ME
Other
Enumeration date
07/20/2007
Last updated
04/01/2013
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