Provider Demographics
NPI:1336896489
Name:MID MAINE ORAL SURGERY
Entity Type:Organization
Organization Name:MID MAINE ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:L'HEUREUX
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:207-649-6664
Mailing Address - Street 1:18 EATON DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4511
Mailing Address - Country:US
Mailing Address - Phone:207-649-6664
Mailing Address - Fax:
Practice Address - Street 1:244 KENNEDY MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4538
Practice Address - Country:US
Practice Address - Phone:207-873-0117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MACAN HOLDINGS PA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-08
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1780995712Medicaid