=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992391536
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAINELY SMILES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2020
-----------------------------------------------------
Last Update Date | 02/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 AUBURN ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04103-6003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-808-9498
-----------------------------------------------------
Fax | 207-420-2455
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117 AUBURN ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04103-6003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-808-9498
-----------------------------------------------------
Fax | 207-420-2455
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF FINANCE
-----------------------------------------------------
Name | MICHAEL LOMBARDI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 603-475-9909
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223D0001X
-----------------------------------------------------
Taxonomy Name | Public Health Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------