Healthcare Provider Details

I. General information

NPI: 1760586135
Provider Name (Legal Business Name): ORAL & MAXILLOFACIAL SURGEONS OF THE MIDCOAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 NORTHPORT AVE
BELFAST ME
04915
US

IV. Provider business mailing address

189 NORTHPORT AVE
BELFAST ME
04915
US

V. Phone/Fax

Practice location:
  • Phone: 207-338-0273
  • Fax: 207-338-0275
Mailing address:
  • Phone: 207-338-0273
  • Fax: 207-338-0275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2362
License Number StateME

VIII. Authorized Official

Name: DR. CYNTHIA ANN BATTEL
Title or Position: OWNER
Credential: DDS
Phone: 207-338-0273