Healthcare Provider Details

I. General information

NPI: 1972774818
Provider Name (Legal Business Name): MICHAEL R NAWFEL DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46B FIRST PARK DRIVE
OAKLAND ME
04963
US

IV. Provider business mailing address

46B FIRST PARK DRIVE
OAKLAND ME
04963
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-2889
  • Fax: 207-872-7159
Mailing address:
  • Phone: 207-872-2889
  • Fax: 207-872-7159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2971
License Number StateME

VIII. Authorized Official

Name: DR. MICHAEL R NAWFEL
Title or Position: PRESIDENT
Credential: DMD
Phone: 207-872-2889