Provider Demographics
NPI:1740412899
Name:MAINE DENTAL GROUP, P.C.
Entity Type:Organization
Organization Name:MAINE DENTAL GROUP, P.C.
Other - Org Name:GENTLE DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-207-1689
Mailing Address - Street 1:440 NARRAGANSETT TRL
Mailing Address - Street 2:
Mailing Address - City:BUXTON
Mailing Address - State:ME
Mailing Address - Zip Code:04093-6505
Mailing Address - Country:US
Mailing Address - Phone:207-929-3900
Mailing Address - Fax:207-929-3907
Practice Address - Street 1:473 ALFRED ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9465
Practice Address - Country:US
Practice Address - Phone:207-283-3775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty