Provider Demographics
NPI:1528189826
Name:PETER T CYR DMD PA
Entity Type:Organization
Organization Name:PETER T CYR DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:T
Authorized Official - Last Name:CYR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-772-4128
Mailing Address - Street 1:68 DEERING ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2212
Mailing Address - Country:US
Mailing Address - Phone:207-772-4128
Mailing Address - Fax:207-772-9045
Practice Address - Street 1:68 DEERING ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2212
Practice Address - Country:US
Practice Address - Phone:207-772-4128
Practice Address - Fax:207-772-9045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME21171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1821061284OtherNPI TYPE 1