Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DTR5538 | ME |
NPI | 1346810892 |
---|---|
Provider Name | Mr. Jeremiah Naas |
First Address | Waterville, ME 04901-5114 |
Second Address | Waterville, ME 04901-5114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2021 |
Last Update Date | 28/06/2021 |