Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 5054 | ME |
NPI | 1003041609 |
---|---|
Provider Name | Sherry M Bodge |
First Address | Bangor, ME 04401-3984 |
Second Address | Bangor, ME 04401-3984 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2009 |
Last Update Date | 27/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
432235099 | (05) | ME |