Provider Demographics
NPI:1023549615
Name:GAGNON DENTAL
Entity Type:Organization
Organization Name:GAGNON DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-626-3091
Mailing Address - Street 1:14 MERRILL ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:ME
Mailing Address - Zip Code:04344-1622
Mailing Address - Country:US
Mailing Address - Phone:207-626-3091
Mailing Address - Fax:207-622-5499
Practice Address - Street 1:14 MERRILL ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:ME
Practice Address - Zip Code:04344-1622
Practice Address - Country:US
Practice Address - Phone:207-626-3091
Practice Address - Fax:207-622-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME37381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty