Healthcare Provider Details

I. General information

NPI: 1225234966
Provider Name (Legal Business Name): PROSTHODONTICS ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 WESTERN AVE
SOUTH PORTLAND ME
04106-1724
US

IV. Provider business mailing address

440 WESTERN AVE
SOUTH PORTLAND ME
04106-1724
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-6348
  • Fax: 207-775-6311
Mailing address:
  • Phone: 207-775-6348
  • Fax: 207-775-6311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number StateME

VIII. Authorized Official

Name: DR. BRUCE J. SAHRBECK
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 207-775-6348