Provider Demographics
NPI:1841230265
Name:CENTER STREET DENTAL, PA
Entity Type:Organization
Organization Name:CENTER STREET DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-784-2211
Mailing Address - Street 1:26 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-6088
Mailing Address - Country:US
Mailing Address - Phone:207-784-2211
Mailing Address - Fax:207-784-2040
Practice Address - Street 1:26 CENTER ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6088
Practice Address - Country:US
Practice Address - Phone:207-784-2211
Practice Address - Fax:207-784-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME24851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty