Provider Demographics
NPI:1679923643
Name:ANDREA M. TALIENTO, DMD, P.A.
Entity Type:Organization
Organization Name:ANDREA M. TALIENTO, DMD, P.A.
Other - Org Name:MAPLEWOOD DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:TALIENTO
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-839-6266
Mailing Address - Street 1:405 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1311
Mailing Address - Country:US
Mailing Address - Phone:207-839-6266
Mailing Address - Fax:207-839-7019
Practice Address - Street 1:405 MAIN ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1311
Practice Address - Country:US
Practice Address - Phone:207-839-6266
Practice Address - Fax:207-839-7019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN40351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty