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General NPI Number Information
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NPI Number | 1891236766
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Entity Type | Organization
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Legal Business Name | COREY J. TEGUIS DMD PA
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 05/16/2017
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Provider Practice Location Address
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Address Line | 28 W COLE RD STE 102
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City | BIDDEFORD
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State | ME
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Zip | 04005-9428
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Country | US
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Telephone | 207-282-5682
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Fax | 207-282-3598
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Provider Business Mailing Address
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Address Line | 28 WEST COLE RD SUITE 102
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City | BIDDEFORD
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State | ME
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Zip | 04005
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Country | US
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Telephone | 207-282-5682
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Fax | 207-282-3598
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Authorized Official
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Title or Position | OWNER
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Name | DR. COREY J TEGUIS
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Credential |
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Telephone | 207-282-5682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2589
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3652
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License Number State | ME
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