Provider Demographics
NPI:1700982329
Name:DOSS, JEFFREY B (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:B
Last Name:DOSS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 WESTERN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-774-2611
Mailing Address - Fax:207-774-2613
Practice Address - Street 1:12 DRIVE IN LN
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5818
Practice Address - Country:US
Practice Address - Phone:207-892-3100
Practice Address - Fax:207-893-1355
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME32831223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME322210099Medicaid
U24047Medicare UPIN
MM3965Medicare ID - Type Unspecified