Healthcare Provider Details

I. General information

NPI: 1043200868
Provider Name (Legal Business Name): GREGORY V SARKA DDS,MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 FOREST AVE UNIT 5
PORTLAND ME
04103-1889
US

IV. Provider business mailing address

1250 FOREST AVE UNIT 5
PORTLAND ME
04103-1889
US

V. Phone/Fax

Practice location:
  • Phone: 207-387-2055
  • Fax: 207-387-2022
Mailing address:
  • Phone: 207-387-2055
  • Fax: 207-387-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3720
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: