Provider Demographics
NPI:1366854838
Name:GREGORY V SARKA, DDS, MD, LLC
Entity Type:Organization
Organization Name:GREGORY V SARKA, DDS, MD, LLC
Other - Org Name:PORTLAND ORAL AND MAXILLOFACIAL SURGURY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:V
Authorized Official - Last Name:SARKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:207-712-9103
Mailing Address - Street 1:33 WELLS ROAD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-5115
Mailing Address - Country:US
Mailing Address - Phone:207-712-9103
Mailing Address - Fax:207-517-2107
Practice Address - Street 1:1250 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103
Practice Address - Country:US
Practice Address - Phone:207-387-2055
Practice Address - Fax:207-387-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME37201223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty