Provider Demographics
NPI:1275634412
Name:NADEAU ORTHODONTICS PA
Entity Type:Organization
Organization Name:NADEAU ORTHODONTICS PA
Other - Org Name:DR MARK NADEAU
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDMUND
Authorized Official - Last Name:NADEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-985-8999
Mailing Address - Street 1:63 PORTLAND ROAD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043
Mailing Address - Country:US
Mailing Address - Phone:207-985-8999
Mailing Address - Fax:207-985-8965
Practice Address - Street 1:63 PORTLAND ROAD
Practice Address - Street 2:SUITE 5
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043
Practice Address - Country:US
Practice Address - Phone:207-985-8999
Practice Address - Fax:207-985-8965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3590122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty