Healthcare Provider Details

I. General information

NPI: 1487539037
Provider Name (Legal Business Name): DOWNEAST-BRUNSWICK PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 CENTER ST
BRUNSWICK ME
04011-1504
US

IV. Provider business mailing address

716 N COUNTRY CLUB RD
TUCSON AZ
85716-4591
US

V. Phone/Fax

Practice location:
  • Phone: 207-517-1011
  • Fax:
Mailing address:
  • Phone: 520-326-8516
  • Fax: 520-326-1013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MARIAH THIBAULT
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 520-276-2220