Provider Demographics
NPI:1801433750
Name:MAINELY KIDS & TEENS, LLC
Entity type:Organization
Organization Name:MAINELY KIDS & TEENS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BATEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-974-3018
Mailing Address - Street 1:1 CUMBERLAND PL STE 116
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5087
Mailing Address - Country:US
Mailing Address - Phone:207-974-3018
Mailing Address - Fax:207-974-3067
Practice Address - Street 1:8 SHUMAN AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7751
Practice Address - Country:US
Practice Address - Phone:207-974-3018
Practice Address - Fax:207-974-3067
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAINELY KIDS & TEENS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-10
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty