Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 5505 | ME |
NPI | 1225285539 |
---|---|
Provider Name | Mr. Michael Kenneth Stewart Firth |
First Address | Sanford, ME 04073-3660 |
Second Address | Sanford, ME 04073-3660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2008 |
Last Update Date | 19/08/2008 |