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General NPI Number Information
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NPI Number | 1467528851
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Entity Type | Organization
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Legal Business Name | COMMUNITY DENTAL
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 190 PARK AVE
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City | PORTLAND
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State | ME
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Zip | 04102-2910
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Country | US
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Telephone | 207-874-1028
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Fax | 207-842-2963
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Provider Business Mailing Address
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Address Line | 190 PARK AVE
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City | PORTLAND
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State | ME
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Zip | 04102-2910
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Country | US
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Telephone | 207-874-1028
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Fax | 207-842-2963
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Authorized Official
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Title or Position | IT COORDINATOR
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Name | SHELLEY PELKEY
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Credential |
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Telephone | 207-874-1025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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