Healthcare Provider Details

I. General information

NPI: 1578771465
Provider Name (Legal Business Name): NORTHERN MAINE ORAL & FACIAL SURGERY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 ACADEMY STREET SUITE #1
PRESQUE ISLE ME
04769-3178
US

IV. Provider business mailing address

181 ACADEMY STREET SUITE #1
PRESQUE ISLE ME
04769-3178
US

V. Phone/Fax

Practice location:
  • Phone: 207-764-6337
  • Fax: 207-764-1446
Mailing address:
  • Phone: 207-764-6337
  • Fax: 207-764-1446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3426
License Number StateME

VIII. Authorized Official

Name: MRS. DEBBIE L ROONEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 207-764-6337