Lisbon Family Dental Care

Key facts

NPI

1083003255

Entity type

Organization (NPI type 2)

Primary specialty

Dentist 122300000X

License

4065 (ME)

Legal business name

LISBON FAMILY DENTAL CARE

Practice address

568 Lisbon St
Suite 1
Lisbon Falls, ME 04252-1138

Phone

(207) 407-4301

NPI assigned

Jan 12, 2015

Organization subpart

No

Authorized official

Name

Dr. Jenna Pulkka, DMD NPI 1528221116

Title

Dentist

Phone

(207) 751-9404

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jenna T Pulkka, D.M.D General Practice Dentistry · Lisbon Falls, ME · NPI 1528221116
  NPD (past) Authorized official

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 12, 2015.

{
    "created_epoch": "1421020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421020800000",
    "number": "1083003255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 VERANDA ST",
            "address_2": "UNIT 2",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041035554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "568 LISBON ST",
            "address_2": "SUITE 1",
            "city": "LISBON FALLS",
            "state": "ME",
            "postal_code": "042521138",
            "telephone_number": "207-407-4301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISBON FAMILY DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-12",
        "last_updated": "2015-01-12",
        "status": "A",
        "authorized_official_last_name": "PULKKA",
        "authorized_official_first_name": "JENNA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "207-751-9404",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "ME",
            "license": "4065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Lisbon Falls, ME · Dentist in Maine