Healthcare Provider Details

I. General information

NPI: 1649273079
Provider Name (Legal Business Name): RICHARD S. MCGUCKIN DDS, MSC, MAGD, FACP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 06/23/2006

III. Provider practice location address

160 PARK STREET
ORONO ME
04473-4602
US

IV. Provider business mailing address

160 PARK ST
ORONO ME
04473-4602
US

V. Phone/Fax

Practice location:
  • Phone: 207-866-2813
  • Fax: 207-866-3640
Mailing address:
  • Phone: 207-866-2813
  • Fax: 207-866-3640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number03513
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: