Provider Demographics
NPI:1942814488
Name:THOMASTON FAMILY DENTISTRY
Entity type:Organization
Organization Name:THOMASTON FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-357-6775
Mailing Address - Street 1:4 CONGO AVE
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:ME
Mailing Address - Zip Code:04861-3625
Mailing Address - Country:US
Mailing Address - Phone:207-354-6453
Mailing Address - Fax:
Practice Address - Street 1:4 CONGO AVE
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:ME
Practice Address - Zip Code:04861-3625
Practice Address - Country:US
Practice Address - Phone:207-354-6453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental