Provider Demographics
NPI:1942646880
Name:PETER J REPOLE, DMD, PC
Entity Type:Organization
Organization Name:PETER J REPOLE, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:REPOLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-853-6601
Mailing Address - Street 1:30 DEEP COVE RD
Mailing Address - Street 2:
Mailing Address - City:EASTPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04631-3221
Mailing Address - Country:US
Mailing Address - Phone:207-853-6601
Mailing Address - Fax:207-853-6603
Practice Address - Street 1:30 DEEP COVE RD
Practice Address - Street 2:
Practice Address - City:EASTPORT
Practice Address - State:ME
Practice Address - Zip Code:04631-3221
Practice Address - Country:US
Practice Address - Phone:207-853-6601
Practice Address - Fax:207-853-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4281122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty