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General NPI Number Information
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NPI Number | 1679923643
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Entity Type | Organization
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Legal Business Name | ANDREA M. TALIENTO, DMD, P.A.
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Dates
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Enumeration Date | 06/20/2016
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Last Update Date | 06/20/2016
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Provider Practice Location Address
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Address Line | 405 MAIN ST
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City | GORHAM
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State | ME
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Zip | 04038-1311
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Country | US
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Telephone | 207-839-6266
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Fax | 207-839-7019
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Provider Business Mailing Address
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Address Line | 405 MAIN ST
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City | GORHAM
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State | ME
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Zip | 04038-1311
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Country | US
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Telephone | 207-839-6266
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Fax | 207-839-7019
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. ANDREA TALIENTO MCBRIDE
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Credential | D.M.D.
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Telephone | 207-839-6266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN4035
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License Number State | ME
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