Healthcare Provider Details

I. General information

NPI: 1548295520
Provider Name (Legal Business Name): RICHARD PAUL LEMIEUX DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 CONGRESS ST
PORTLAND ME
04102-2144
US

IV. Provider business mailing address

1330 CONGRESS ST
PORTLAND ME
04102-2144
US

V. Phone/Fax

Practice location:
  • Phone: 207-773-6487
  • Fax: 207-773-7653
Mailing address:
  • Phone: 207-773-6487
  • Fax: 207-773-7653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number2703
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: