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NPI

34,232

Facility Name

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First Name

Teresita

Last Name

Jepsen

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

12,345

Are you currently accepting new MaineCare members?

No

Are you able to accommodate children with special needs?

Yes

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?

No

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

Yes

Dental License Number

xxxxxxxxxxxxxxxxxx
Created at 4/25/2019 5:42 AM by ***
Last modified at 4/25/2019 5:42 AM by ***