=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609566843
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAINE ORAL SURGERY AND DENTAL IMPLANT CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2023
-----------------------------------------------------
Last Update Date | 05/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23 WATER ST
-----------------------------------------------------
City | SACO
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04072-5119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-282-6139
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 WATER ST
-----------------------------------------------------
City | SACO
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04072-5119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORAL AND MAXILLOFACIAL SURGEON
-----------------------------------------------------
Name | DR. ERIK JUEL HARRIMAN
-----------------------------------------------------
Credential | DMD, MD
-----------------------------------------------------
Telephone | 207-266-5482
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------