Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DTR5530 | ME |
NPI | 1962944645 |
---|---|
Provider Name | Lindsey April Young |
First Address | Prospect, ME 04981-3401 |
Second Address | Prospect, ME 04981-3401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2016 |
Last Update Date | 10/11/2016 |