Provider Demographics
NPI:1376808816
Name:AUGUSTE, ALAIN WAGNER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAIN
Middle Name:WAGNER
Last Name:AUGUSTE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ALAIN
Other - Middle Name:WAGNER
Other - Last Name:AUGUSTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:728 STILLWATER AVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3615
Mailing Address - Country:US
Mailing Address - Phone:203-252-4916
Mailing Address - Fax:
Practice Address - Street 1:728 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3615
Practice Address - Country:US
Practice Address - Phone:203-252-4916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2021-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0107681223G0001X
ME4280122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice