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General NPI Number Information
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NPI Number | 1962239103
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Entity Type | Organization
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Legal Business Name | COASTAL MAINE ORAL & MAXILLOFACIAL SURGERY PA
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Dates
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Enumeration Date | 09/19/2024
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 180 US ROUTE 1
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City | SCARBOROUGH
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State | ME
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Zip | 04074
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Country | US
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Telephone | 207-401-5006
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Fax |
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Provider Business Mailing Address
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Address Line | 180 US ROUTE 1
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City | SCARBOROUGH
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State | ME
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Zip | 04074
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Country | US
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Telephone | 207-401-5006
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY BOWMAN DOSS
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Credential | DDS
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Telephone | 207-838-6029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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