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General NPI Number Information
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NPI Number | 1942205059
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Entity Type | Individual
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Provider Name | GARY R. BADGER DDS,MS
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Gender | Male
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 716 STEVENS AVE THE UNIVERSITY OF NEW ENGLAND COLLEGE OF DENTISTRY
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City | PORTLAND
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State | ME
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Zip | 04103-2670
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Country | US
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Telephone | 207-221-4747
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Fax | 713-486-4142
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Provider Business Mailing Address
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Address Line | 1306 HARPSWELL ISLANDS RD
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City | ORRS ISLAND
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State | ME
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Zip | 04066
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Country | US
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Telephone | 979-777-6542
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 17315
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2282
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License Number State | ME
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