Provider Demographics
NPI:1073538427
Name:DETTMANN, DAVID A (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:DETTMANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 4140
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-4140
Mailing Address - Country:US
Mailing Address - Phone:207-777-4111
Mailing Address - Fax:207-783-6660
Practice Address - Street 1:100 CAMPUS AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6040
Practice Address - Country:US
Practice Address - Phone:207-777-8974
Practice Address - Fax:207-777-8946
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME16582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME337840099Medicaid
ME337840099Medicaid
MEG54155Medicare UPIN