Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 5023 | ME |
NPI | 1356550834 |
---|---|
Provider Name | Mr. Philip Sanguedolce |
First Address | Kittery, ME 03904-6000 |
Second Address | Kittery, ME 03904-6000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 09/07/2007 |