Independent Denture Center PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

5024 Issued in ME

Legal business name

INDEPENDENT DENTURE CENTER PC

Practice address

530 Roosevelt TRL
Windham, ME 04062-4901

Phone

(207) 893-1346

Fax

(207) 893-0114

NPI assigned

Oct 21, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Kelly Carbone Richardson, LD

Title

President

Phone

(207) 893-1346

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jetport Denture Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287619200000",
    "number": "1649580853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1018",
            "city": "WINDHAM",
            "state": "ME",
            "postal_code": "040621018",
            "telephone_number": "207-893-1346",
            "fax_number": "207-893-0114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 ROOSEVELT TRL",
            "city": "WINDHAM",
            "state": "ME",
            "postal_code": "040624901",
            "telephone_number": "207-893-1346",
            "fax_number": "207-893-0114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT DENTURE CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-21",
        "last_updated": "2010-10-21",
        "status": "A",
        "authorized_official_last_name": "CARBONE RICHARDSON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "207-893-1346",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ME",
            "license": "5024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "433189000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jetport Denture Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Home Support Services, LLC
• Mary Amalie Horn, LCPC
• Sara K Hosseini, DMD
• Howland W. Bickerstaff
• Humanity Residential Care LLC
• Kristen Cushman Inman, MOT, OTR/L
• Innovative Prosthetic Solutions, Inc
• Richard Michael Intiso, DMD PA
• Fabrice Iraduha
• Blaise Ishimwe, DSP

• Dental Clinic/Center in Windham, ME
• Providers in Windham, ME by specialty
• Dental Clinic/Center in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.