Provider Demographics
NPI:1821193814
Name:TROWBRIDGE, GORDON PRESCOTT III (DMD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:PRESCOTT
Last Name:TROWBRIDGE
Suffix:III
Gender:M
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:PO BOX 36
Mailing Address - Street 2:45 MAIN STREET
Mailing Address - City:MILBRIDGE
Mailing Address - State:ME
Mailing Address - Zip Code:04658-0036
Mailing Address - Country:US
Mailing Address - Phone:207-546-2302
Mailing Address - Fax:207-546-2303
Practice Address - Street 1:45 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MILBRIDGE
Practice Address - State:ME
Practice Address - Zip Code:04658-0036
Practice Address - Country:US
Practice Address - Phone:207-546-2302
Practice Address - Fax:207-546-2303
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME27881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice