Provider Demographics
NPI:1013274067
Name:KATAHDIN PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:KATAHDIN PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GASTON
Authorized Official - Middle Name:
Authorized Official - Last Name:TO'OLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MS
Authorized Official - Phone:207-942-0593
Mailing Address - Street 1:24 PENN PLZ
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3620
Mailing Address - Country:US
Mailing Address - Phone:207-942-0593
Mailing Address - Fax:207-947-5237
Practice Address - Street 1:24 PENN PLZ
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3620
Practice Address - Country:US
Practice Address - Phone:207-942-0593
Practice Address - Fax:207-947-5237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME40961223P0221X
ME30631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty