Provider Demographics
NPI:1811359094
Name:BROWN, WILLIAM PAGE (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PAGE
Last Name:BROWN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 STILLWATER AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3616
Mailing Address - Country:US
Mailing Address - Phone:207-942-1442
Mailing Address - Fax:
Practice Address - Street 1:766 STILLWATER AVE STE 2
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3616
Practice Address - Country:US
Practice Address - Phone:207-942-1442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WADE608832901223X0400X
MEDEN50101223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty