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General NPI Number Information
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NPI Number | 1396408191
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Entity Type | Organization
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Legal Business Name | TYLER J. GAGNON DMD PA LLC
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Dates
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Enumeration Date | 10/19/2021
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Last Update Date | 10/19/2021
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Provider Practice Location Address
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Address Line | 227 MOUNT AUBURN AVE
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City | AUBURN
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State | ME
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Zip | 04210-8521
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Country | US
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Telephone | 207-782-3971
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Fax |
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Provider Business Mailing Address
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Address Line | 227 MOUNT AUBURN AVE
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City | AUBURN
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State | ME
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Zip | 04210-8521
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Country | US
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Telephone | 207-782-3971
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TYLER JOSEPH GAGNON
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Credential | DMD
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Telephone | 207-782-3971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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