Provider Demographics
NPI:1245484310
Name:AMERICAN DENTAL ASSOCIATES
Entity type:Organization
Organization Name:AMERICAN DENTAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUGBENGA
Authorized Official - Middle Name:A
Authorized Official - Last Name:AKINSANYA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-872-6815
Mailing Address - Street 1:179 MAIN ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6672
Mailing Address - Country:US
Mailing Address - Phone:207-872-6815
Mailing Address - Fax:207-872-6815
Practice Address - Street 1:179 MAIN ST
Practice Address - Street 2:SUITE 212
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6672
Practice Address - Country:US
Practice Address - Phone:207-872-6815
Practice Address - Fax:207-872-6815
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN DENTAL ASSOCIATES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-16
Last Update Date:2008-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME40771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty