Provider Demographics
NPI:1699245589
Name:PARADIGM DENTAL PC
Entity type:Organization
Organization Name:PARADIGM DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:ELWOOD
Authorized Official - Last Name:L'ITALIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-951-0712
Mailing Address - Street 1:10 GRANITE WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-5747
Mailing Address - Country:US
Mailing Address - Phone:207-236-2400
Mailing Address - Fax:
Practice Address - Street 1:10 GRANITE WAY
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-5747
Practice Address - Country:US
Practice Address - Phone:207-236-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty