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NPI

645

Facility Name

idngg

First Name

slot

Last Name

agen

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

https://159.65.11.52

Physical City

ca

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

ca

Physical Zip Code

90,011

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?

No

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

 
Created at 12/6/2021 6:08 AM by ***
Last modified at 12/6/2021 6:08 AM by ***