Organization
JETPORT DENTURE CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AUSTIN CARBONE LD (OWNER)
(207) 774-7645
Entity
Organization
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DTR5001
STATE OF MAINE DENTURIST LICENSE
ME
Enumeration date
10/06/2022
Last updated
10/06/2022
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