Provider Demographics
NPI:1972962835
Name:TWIN CITY DENTAL
Entity type:Organization
Organization Name:TWIN CITY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:D
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-947-3939
Mailing Address - Street 1:151 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5319
Mailing Address - Country:US
Mailing Address - Phone:207-947-3939
Mailing Address - Fax:
Practice Address - Street 1:151 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5319
Practice Address - Country:US
Practice Address - Phone:207-947-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty