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General NPI Number Information
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NPI Number | 1770831224
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Entity Type | Organization
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Legal Business Name | GORHAM FAMILY AND COSMETIC DENTISTRY PC
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 347 MAIN ST
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City | GORHAM
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State | ME
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Zip | 04038-1338
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Country | US
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Telephone | 207-839-3006
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Fax | 207-839-4593
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Provider Business Mailing Address
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Address Line | 347 MAIN ST
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City | GORHAM
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State | ME
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Zip | 04038-1338
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Country | US
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Telephone | 207-839-3006
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Fax | 207-839-4593
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER W PIDHAJECKY
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Credential | GENERAL DENTIST
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Telephone | 207-839-3006
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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 | 4251
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License Number State | NY
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