Provider Demographics
NPI:1740815976
Name:DOUGLAS H MACGILPIN, LLC
Entity type:Organization
Organization Name:DOUGLAS H MACGILPIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MACGILPIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:207-729-8756
Mailing Address - Street 1:80 BARIBEAU DR STE 2
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3218
Mailing Address - Country:US
Mailing Address - Phone:207-729-8756
Mailing Address - Fax:
Practice Address - Street 1:80 BARIBEAU DR STE 2
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3218
Practice Address - Country:US
Practice Address - Phone:207-729-8756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1932124690OtherORTHODONTIST