Healthcare Provider Details

I. General information

NPI: 1720206238
Provider Name (Legal Business Name): ARTHUR HOUGH GAGER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL CENTER DR
BIDDEFORD ME
04005-9400
US

IV. Provider business mailing address

2 MEDICAL CENTER DR
BIDDEFORD ME
04005-9400
US

V. Phone/Fax

Practice location:
  • Phone: 207-283-4867
  • Fax: 207-283-4496
Mailing address:
  • Phone: 207-283-4867
  • Fax: 207-283-4496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3133
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: