Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DTR5532 | ME |
NPI | 1972047470 |
---|---|
Provider Name | Ms. Elizabeth Laura Stevens |
First Address | Milo, ME 04463-1756 |
Second Address | Bangor, ME 04401-3984 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2016 |
Last Update Date | 19/12/2016 |