SOUTHERN MAINE PEDIATRIC DENTISTRY NPI 1184814568

NPI Information

SOUTHERN MAINE PEDIATRIC DENTISTRY is a dental clinic center in South Portland, ME. SOUTHERN MAINE PEDIATRIC DENTISTRY NPI is 1184814568. The provider is registered as an organization entity type.

The provider's business location address is:

75 JOHN ROBERTS RD
SUIT 10B
SOUTH PORTLAND, ME
ZIP 04106-914
Phone: (207) 773-3111

The provider's authorized official is Whitney Ralston Wignall .
The authorized official title is Pediatric Dentist and has the following contact phone number (207) 773-3111.

The enumeration date for this NPI number is 7/31/2007 and was last updated on 7/31/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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