Provider Demographics
NPI:1033741905
Name:ROOT DENTAL SPECIALISTS
Entity Type:Organization
Organization Name:ROOT DENTAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TANGREDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-405-0004
Mailing Address - Street 1:192 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2428
Mailing Address - Country:US
Mailing Address - Phone:207-405-0004
Mailing Address - Fax:207-405-0004
Practice Address - Street 1:192 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2428
Practice Address - Country:US
Practice Address - Phone:207-405-0004
Practice Address - Fax:207-405-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty