Healthcare Provider Details

I. General information

NPI: 1255373593
Provider Name (Legal Business Name): SCARBOROUGH DENTAL ASSOCIATION, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 US ROUTE 1 SUITE 2
SCARBOROUGH ME
04074-7400
US

IV. Provider business mailing address

243 US ROUTE 1 SUITE 2
SCARBOROUGH ME
04074-7400
US

V. Phone/Fax

Practice location:
  • Phone: 207-883-8911
  • Fax: 207-883-6915
Mailing address:
  • Phone: 207-883-8911
  • Fax: 207-883-6915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2539
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2979
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2416
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3618
License Number StateME

VIII. Authorized Official

Name: DR. MARK R. BUTTARAZZI
Title or Position: DENTIST
Credential: D.M.D.
Phone: 207-883-8911