Healthcare Provider Details

I. General information

NPI: 1366854838
Provider Name (Legal Business Name): GREGORY V SARKA, DDS, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 02/01/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 FOREST AVE
PORTLAND ME
04103
US

IV. Provider business mailing address

33 WELLS ROAD
CAPE ELIZABETH ME
04107-5115
US

V. Phone/Fax

Practice location:
  • Phone: 207-387-2055
  • Fax: 207-387-2022
Mailing address:
  • Phone: 207-712-9103
  • Fax: 207-517-2107

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: DR. GREGORY V. SARKA
Title or Position: OWNER
Credential: DDS, MD
Phone: 207-712-9103