Provider Demographics
NPI:1891236766
Name:COREY J. TEGUIS DMD PA
Entity Type:Organization
Organization Name:COREY J. TEGUIS DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TEGUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-282-5682
Mailing Address - Street 1:28 WEST COLE RD SUITE 102
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005
Mailing Address - Country:US
Mailing Address - Phone:207-282-5682
Mailing Address - Fax:207-282-3598
Practice Address - Street 1:28 W COLE RD STE 102
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9428
Practice Address - Country:US
Practice Address - Phone:207-282-5682
Practice Address - Fax:207-282-3598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36521223X0400X
ME25891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME=========OtherMAINECARE