Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 5051 | ME |
NPI | 1043637093 |
---|---|
Provider Name | Astrid Chiasson |
First Address | Standish, ME 04084-0549 |
Second Address | Standish, ME 04084-6147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2014 |
Last Update Date | 27/03/2014 |