Healthcare Provider Details

I. General information

NPI: 1093765349
Provider Name (Legal Business Name): GREGORY J. PAPPAS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 ELM ST
NEWPORT ME
04953-3125
US

IV. Provider business mailing address

42 ELM ST
NEWPORT ME
04953-3125
US

V. Phone/Fax

Practice location:
  • Phone: 207-368-4325
  • Fax: 207-368-5079
Mailing address:
  • Phone: 207-368-4325
  • Fax: 207-368-5079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3060
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: