NPI: 1407029184 · WINTHROP, ME 04364 · Dental Clinic/Center · NPI assigned 04/02/2008
| Authorized Official | WIETECHA, JAY (OWNER) |
| NPI Enumeration Date | 04/02/2008 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 15 | $390.00 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | Prophylaxis - child | 15 | 15 | $390.00 |