Provider Demographics
NPI:1215197439
Name:JAMES G HABAS DDS LLC
Entity Type:Organization
Organization Name:JAMES G HABAS DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:HABAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-646-2901
Mailing Address - Street 1:PO BOX 2141
Mailing Address - Street 2:
Mailing Address - City:OGUNQUIT
Mailing Address - State:ME
Mailing Address - Zip Code:03907-2141
Mailing Address - Country:US
Mailing Address - Phone:207-646-2901
Mailing Address - Fax:
Practice Address - Street 1:271 MAIN ST
Practice Address - Street 2:
Practice Address - City:OGUNQUIT
Practice Address - State:ME
Practice Address - Zip Code:03907-2141
Practice Address - Country:US
Practice Address - Phone:207-646-2901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2790261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME110370000Medicaid