Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DTR5027 | ME |
NPI | 1962979831 |
---|---|
Provider Name | Mrs. Anita C Ogle |
First Address | Standish, ME 04084-0549 |
Second Address | Standish, ME 04084 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2018 |
Last Update Date | 30/10/2018 |