Provider Demographics
NPI:1760512446
Name:MAINE FAMILY DENTAL PRACTICE PA
Entity type:Organization
Organization Name:MAINE FAMILY DENTAL PRACTICE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-947-1166
Mailing Address - Street 1:277 STATE ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-947-1166
Mailing Address - Fax:207-947-6123
Practice Address - Street 1:277 STATE ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-947-1166
Practice Address - Fax:207-947-6123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2413122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty