Provider Demographics
NPI:1376764829
Name:ROBERT A PATENAUDE DDS PA
Entity Type:Organization
Organization Name:ROBERT A PATENAUDE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATENAUDE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-623-8122
Mailing Address - Street 1:169 WATER STREET
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330
Mailing Address - Country:US
Mailing Address - Phone:207-623-8122
Mailing Address - Fax:207-623-3907
Practice Address - Street 1:169 WATER STREET
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-623-8122
Practice Address - Fax:207-623-3907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME10482000Medicaid