Provider Demographics
NPI:1942205059
Name:BADGER, GARY R (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
Last Name:BADGER
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1306 HARPSWELL ISLANDS RD
Mailing Address - Street 2:
Mailing Address - City:ORRS ISLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04066
Mailing Address - Country:US
Mailing Address - Phone:979-777-6542
Mailing Address - Fax:
Practice Address - Street 1:716 STEVENS AVE
Practice Address - Street 2:THE UNIVERSITY OF NEW ENGLAND COLLEGE OF DENTISTRY
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2670
Practice Address - Country:US
Practice Address - Phone:207-221-4747
Practice Address - Fax:713-486-4142
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX173151223P0221X
ME22821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry