Provider Demographics
NPI:1407076714
Name:CHARLES H. DORR, DDS, PA
Entity Type:Organization
Organization Name:CHARLES H. DORR, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:DORR
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-255-8832
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:25 HADLEY LAKE ROAD
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-0528
Mailing Address - Country:US
Mailing Address - Phone:207-255-3352
Mailing Address - Fax:207-255-8832
Practice Address - Street 1:25 HADLEY LAKE ROAD
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654
Practice Address - Country:US
Practice Address - Phone:207-255-3352
Practice Address - Fax:207-255-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2420122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty