Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 5008 | ME |
NPI | 1871879411 |
---|---|
Provider Name | Mr. Mitchel Jones |
First Address | Westbrook, ME 04092-3733 |
Second Address | Westbrook, ME 04092-3733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2011 |
Last Update Date | 27/10/2011 |