Provider Demographics
NPI:1043200868
Name:SARKA, GREGORY V (DDS,MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:V
Last Name:SARKA
Suffix:
Gender:M
Credentials:DDS,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 FOREST AVE UNIT 5
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1889
Mailing Address - Country:US
Mailing Address - Phone:207-387-2055
Mailing Address - Fax:207-387-2022
Practice Address - Street 1:1250 FOREST AVE UNIT 5
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-1889
Practice Address - Country:US
Practice Address - Phone:207-387-2055
Practice Address - Fax:207-387-2022
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME37201223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME0736OtherMEDICARE
MEME0736OtherMEDICARE
I10573Medicare UPIN