Provider Demographics
NPI:1659496362
Name:CARON, DENISE J (DMD)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:J
Last Name:CARON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3670
Mailing Address - Country:US
Mailing Address - Phone:207-797-5834
Mailing Address - Fax:207-797-8305
Practice Address - Street 1:1334 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3670
Practice Address - Country:US
Practice Address - Phone:207-797-5834
Practice Address - Fax:207-797-8305
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME29271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
462767OtherBCBS