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Organization

INTERDENT LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. GLEN FREDERIC ABBOTT II D.D.S. (PRESIDENT)
(207) 776-9776
Entity
Organization

Contact information

Practice address
12 SHUMAN AVE, AUGUSTA, ME 04330-6020
(207) 623-7580
Mailing address
12 SHUMAN AVE, AUGUSTA, ME 04330-6020
(207) 623-7580

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3757
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
435721099
MAINE CARE
ME
Enumeration date
06/02/2011
Last updated
06/02/2011
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