Healthcare Provider Details

I. General information

NPI: 1457553182
Provider Name (Legal Business Name): MAINE PROSTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 FOREST AVENUE
PORTLAND ME
04103
US

IV. Provider business mailing address

1250 FOREST AVENUE
PORTLAND ME
04103
US

V. Phone/Fax

Practice location:
  • Phone: 207-773-6177
  • Fax: 207-773-6552
Mailing address:
  • Phone: 207-773-6177
  • Fax: 207-773-6552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2624
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number3398
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number3784
License Number StateME

VIII. Authorized Official

Name: DR. FRANK A MUSCIANO
Title or Position: OFFICIAL
Credential: DDS
Phone: 207-773-6177