Healthcare Provider Details

I. General information

NPI: 1871116319
Provider Name (Legal Business Name): THOMAS B HALPIN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 UNION ST
BANGOR ME
04401-3016
US

IV. Provider business mailing address

PO BOX 1599
BANGOR ME
04402-1599
US

V. Phone/Fax

Practice location:
  • Phone: 207-404-8100
  • Fax: 207-947-0435
Mailing address:
  • Phone: 207-404-8200
  • Fax: 207-947-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN4803
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: