Provider Demographics
NPI:1255373593
Name:SCARBOROUGH DENTAL ASSOCIATION, P.A.
Entity type:Organization
Organization Name:SCARBOROUGH DENTAL ASSOCIATION, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:BUTTARAZZI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-883-8911
Mailing Address - Street 1:243 US ROUTE 1
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7400
Mailing Address - Country:US
Mailing Address - Phone:207-883-8911
Mailing Address - Fax:207-883-6915
Practice Address - Street 1:243 US ROUTE 1
Practice Address - Street 2:SUITE 2
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7400
Practice Address - Country:US
Practice Address - Phone:207-883-8911
Practice Address - Fax:207-883-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME29791223G0001X
ME24161223G0001X
ME36181223G0001X
ME25391223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty