Provider Demographics
NPI:1578771465
Name:NORTHERN MAINE ORAL & FACIAL SURGERY PA
Entity Type:Organization
Organization Name:NORTHERN MAINE ORAL & FACIAL SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-764-6337
Mailing Address - Street 1:181 ACADEMY STREET
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3178
Mailing Address - Country:US
Mailing Address - Phone:207-764-6337
Mailing Address - Fax:207-764-1446
Practice Address - Street 1:181 ACADEMY STREET
Practice Address - Street 2:SUITE #1
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3178
Practice Address - Country:US
Practice Address - Phone:207-764-6337
Practice Address - Fax:207-764-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME34261223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME9760835OtherCIGNA
ME132730000Medicaid
ME2209645OtherAETNA
ME132730000Medicaid
ME0014772Medicare PIN
ME9760835OtherCIGNA