Provider Demographics
NPI:1962442806
Name:DOWD, SHAUN N (DMD)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:N
Last Name:DOWD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5351
Mailing Address - Country:US
Mailing Address - Phone:207-947-4767
Mailing Address - Fax:207-947-7112
Practice Address - Street 1:72 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5351
Practice Address - Country:US
Practice Address - Phone:207-947-4767
Practice Address - Fax:207-947-7112
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME20981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME828257OtherUNITED CONCORDIA