Healthcare Provider Details

I. General information

NPI: 1962239103
Provider Name (Legal Business Name): COASTAL MAINE ORAL & MAXILLOFACIAL SURGERY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 US ROUTE 1
SCARBOROUGH ME
04074
US

IV. Provider business mailing address

180 US ROUTE 1
SCARBOROUGH ME
04074
US

V. Phone/Fax

Practice location:
  • Phone: 207-401-5006
  • Fax:
Mailing address:
  • Phone: 207-401-5006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEFFREY BOWMAN DOSS
Title or Position: PRESIDENT
Credential: DDS
Phone: 207-838-6029