Healthcare Provider Details

I. General information

NPI: 1700098241
Provider Name (Legal Business Name): CROSSWAY FAMILY DENTAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MARKET SQUARE SUITE #3
SOUTH PARIS ME
04281
US

IV. Provider business mailing address

10 MARKET SQUARE SUITE #3
SOUTH PARIS ME
04281
US

V. Phone/Fax

Practice location:
  • Phone: 207-743-8701
  • Fax: 207-743-2787
Mailing address:
  • Phone: 207-743-8701
  • Fax: 207-743-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. AARON IM
Title or Position: OWNER DENTIST
Credential: DMD
Phone: 207-743-8701