Healthcare Provider Details

I. General information

NPI: 1447478953
Provider Name (Legal Business Name): FREEPORT DENTAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 MALLETT DR
FREEPORT ME
04032-1313
US

IV. Provider business mailing address

46 MALLETT DR
FREEPORT ME
04032-1313
US

V. Phone/Fax

Practice location:
  • Phone: 207-865-3934
  • Fax: 207-865-4590
Mailing address:
  • Phone: 207-865-3934
  • Fax: 207-865-4590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN GOOLD STROUT
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 207-729-7788