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NPI

1,128

Facility Name

Agen Sabung Ayam S128

First Name

Sabung Ayam S128

Last Name

Agen Sabung Ayam S128 Online

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

http://s128raja.com/

Physical City

https://filmfreeway.com/s128ayam

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

https://en.clubcooee.com/users/view/AgenSabungAyam

Physical Zip Code

11

Are you currently accepting new MaineCare members?

No

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?

No

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

No

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

No

Dental License Number

11
Created at 6/30/2020 7:02 AM by ***
Last modified at 6/30/2020 7:02 AM by ***