Provider Demographics
NPI:1316615677
Name:MIND YOUR MOUTH, PA, LLC
Entity type:Organization
Organization Name:MIND YOUR MOUTH, PA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARET
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-747-7369
Mailing Address - Street 1:61 OCEAN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3010
Mailing Address - Country:US
Mailing Address - Phone:207-747-7369
Mailing Address - Fax:
Practice Address - Street 1:225 WATERMAN DR
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3634
Practice Address - Country:US
Practice Address - Phone:207-200-4106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty