Provider Demographics
NPI:1134263981
Name:ESSEX SREET DENTAL ASSOCIATES,PA
Entity type:Organization
Organization Name:ESSEX SREET DENTAL ASSOCIATES,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:YORZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-564-8171
Mailing Address - Street 1:427 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1310
Mailing Address - Country:US
Mailing Address - Phone:207-564-8171
Mailing Address - Fax:207-564-3916
Practice Address - Street 1:427 ESSEX ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1310
Practice Address - Country:US
Practice Address - Phone:207-564-8171
Practice Address - Fax:207-564-3916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3608261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental