Healthcare Provider Details

I. General information

NPI: 1386847846
Provider Name (Legal Business Name): STEGEMANN AND SHUMAN ORTHODONTICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 WASHINGTON AVENUE
PORTLAND ME
04103
US

IV. Provider business mailing address

1321 WASHINGTON AVENUE
PORTLAND ME
04103
US

V. Phone/Fax

Practice location:
  • Phone: 207-797-5577
  • Fax: 207-797-0072
Mailing address:
  • Phone: 207-797-5577
  • Fax: 207-797-0072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: THOMAS A STEGEMANN
Title or Position: OWNER
Credential: DMD
Phone: 207-797-5577