Provider Demographics
NPI:1114969821
Name:JEFF W. DAIGLE D.D.S., P.A.
Entity Type:Organization
Organization Name:JEFF W. DAIGLE D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CLERK
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAIGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-324-1345
Mailing Address - Street 1:11 DAIGLE LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-4173
Mailing Address - Country:US
Mailing Address - Phone:207-324-1345
Mailing Address - Fax:207-324-5168
Practice Address - Street 1:11 DAIGLE LN
Practice Address - Street 2:SUITE A
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-4173
Practice Address - Country:US
Practice Address - Phone:207-324-1345
Practice Address - Fax:207-324-5168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME30381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME004068MEEMedicare UPIN