Provider Demographics
NPI:1497892475
Name:RICHARD P. LEMIEUX D.M.D., PA
Entity Type:Organization
Organization Name:RICHARD P. LEMIEUX D.M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEMIEUX
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-773-6487
Mailing Address - Street 1:1330 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2144
Mailing Address - Country:US
Mailing Address - Phone:207-773-6487
Mailing Address - Fax:207-773-7653
Practice Address - Street 1:1330 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2144
Practice Address - Country:US
Practice Address - Phone:207-773-6487
Practice Address - Fax:207-773-7653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME27031223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME078018Medicare PIN