Provider Demographics
NPI:1386202406
Name:JAMES R CORMIER DMD LLC PA
Entity Type:Organization
Organization Name:JAMES R CORMIER DMD LLC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:CORMIER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-692-6878
Mailing Address - Street 1:5 LINA AVE
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-2409
Mailing Address - Country:US
Mailing Address - Phone:207-692-6878
Mailing Address - Fax:
Practice Address - Street 1:118 YORK ST
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7108
Practice Address - Country:US
Practice Address - Phone:207-985-3796
Practice Address - Fax:207-985-9204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental