Provider Demographics
NPI:1073672176
Name:GERARD M GIRARDIN DDS PA
Entity Type:Organization
Organization Name:GERARD M GIRARDIN DDS PA
Other - Org Name:GERARD M. GIRARDIN D.D.S. P.A.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:GIRARDIN
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-897-4136
Mailing Address - Street 1:115 PARK ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04254-1412
Mailing Address - Country:US
Mailing Address - Phone:207-897-4136
Mailing Address - Fax:207-897-5720
Practice Address - Street 1:115 PARK ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE FALLS
Practice Address - State:ME
Practice Address - Zip Code:04254-1412
Practice Address - Country:US
Practice Address - Phone:207-897-4136
Practice Address - Fax:207-897-5720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME24321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty