Provider Demographics
NPI:1750596664
Name:CHRISTOPHER A CIFIZZAR DDS PA
Entity type:Organization
Organization Name:CHRISTOPHER A CIFIZZAR DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:CIFIZZARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-743-2611
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268
Mailing Address - Country:US
Mailing Address - Phone:207-743-2611
Mailing Address - Fax:207-743-9030
Practice Address - Street 1:15 PEARL ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268
Practice Address - Country:US
Practice Address - Phone:207-743-2611
Practice Address - Fax:207-743-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME31001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty