Provider Demographics
NPI:1881209641
Name:CANDID MAINE PC
Entity Type:Organization
Organization Name:CANDID MAINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AVANZO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-481-7631
Mailing Address - Street 1:44 W 28TH ST FL 14
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4212
Mailing Address - Country:US
Mailing Address - Phone:860-481-7631
Mailing Address - Fax:
Practice Address - Street 1:415 CONGRESS ST STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3500
Practice Address - Country:US
Practice Address - Phone:860-481-7631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty