| Street | 26 Front St | ||
| City/Town | Bangor | ||
| State/Province/Region | Maine | ||
| Zip/Postal Code | 04401 | ||
| Phone Number | (207) 947-8009 | ||
| Country | United States |
| Full Name | Ms. Ellen Funk DDS | ||
| Gender | female | ||
| Birthday | 1988-05-22 | ||
| Social Security Number | 427-99-5500 |
| Credit card brand | Voyager | ||
| Credit card number | 8699062551086530 | ||
| Expire | 2027/10 | ||
| CVV | 284 |