Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DTR5529 | ME |
NPI | 1033686647 |
---|---|
Provider Name | Kurt Edward Bates |
First Address | Presque Isle, ME 04769-3170 |
Second Address | Presque Isle, ME 04769-3170 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2018 |
Last Update Date | 01/11/2018 |