Provider Demographics
NPI:1548542632
Name:FIRST IMPRESSIONS DENTAL LLP
Entity type:Organization
Organization Name:FIRST IMPRESSIONS DENTAL LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:LUCIER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-324-0026
Mailing Address - Street 1:15 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-3915
Mailing Address - Country:US
Mailing Address - Phone:207-324-0026
Mailing Address - Fax:207-324-0013
Practice Address - Street 1:15 W ELM ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3915
Practice Address - Country:US
Practice Address - Phone:207-324-0026
Practice Address - Fax:207-324-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental