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NPI

3,425

Facility Name

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First Name

Cassi

Last Name

Wirth

Physical Street Address -- NOTE:  Please return to complete this Survey separately for each physical service location where you provide dental services.

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Physical City

Maine

Physical State (Please use state abbreviation ex: ME for Maine)

Maine

Physical Zip Code

32,525

Are you currently accepting new MaineCare members?

Yes

Are you able to accommodate children with special needs?

No

Are you able to serve children with mobility issues such as wheelchair ramps and wider doorways?

Yes

Are you able to provide services to children with complex health needs such as sedation?

Yes

Are you able to provide services to children with intellectual disabilities such as autism?

Yes

Dental License Number

xxxxxxxx
Created at 3/4/2019 5:57 AM by ***
Last modified at 3/4/2019 5:57 AM by ***