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General NPI Number Information
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NPI Number | 1487459210
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY ASLEEP OF MAINE
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 55 SPRING ST
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City | SCARBOROUGH
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State | ME
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Zip | 04074-8926
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Country | US
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Telephone | 857-200-3312
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Fax |
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Provider Business Mailing Address
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Address Line | 500 N LEWIS RUN RD STE 215A
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City | WEST MIFFLIN
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State | PA
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Zip | 15122-3009
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Country | US
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Telephone | 857-200-3312
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST / OWNER
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Name | DR. JOHNNY WANA JOSEPH
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Credential | DMD
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Telephone | 857-200-3312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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