Organization
COSMETIC & GENERAL DENTISTRY OF WINTHROP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAY R WIETECHA F.A.G.D. (PROPRIETOR)
(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 AVENUE, WINTHROP, ME 04364
(207) 377-6958
(207) 377-4349
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/20/2007
Last updated
07/20/2007
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