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General NPI Number Information
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NPI Number | 1710002324
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Entity Type | Organization
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Legal Business Name | CITY OF PORTLAND MAINE HHS, PHD
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 389 CONGRESS ST ROOM 307
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City | PORTLAND
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State | ME
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Zip | 04101-3509
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Country | US
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Telephone | 207-874-8784
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Fax |
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Provider Business Mailing Address
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Address Line | 389 CONGRESS ST ROOM 307
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City | PORTLAND
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State | ME
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Zip | 04101-3509
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Country | US
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Telephone | 207-874-8784
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Fax |
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Authorized Official
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Title or Position | CITY MANAGER
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Name | JOSEPH GRAY
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Credential |
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Telephone | 207-874-8689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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