Provider Demographics
NPI:1114151180
Name:CATHOLIC CHARITIES MAINE
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES MAINE
Other - Org Name:JESSE ALBERT DENTAL AND ORTHODONTIC CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LETOURNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-781-8550
Mailing Address - Street 1:307 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3638
Mailing Address - Country:US
Mailing Address - Phone:207-781-8550
Mailing Address - Fax:
Practice Address - Street 1:171 CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-1531
Practice Address - Country:US
Practice Address - Phone:207-443-9721
Practice Address - Fax:207-443-9722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental