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NPI Code Detail

MEDICARE: RICHARD INTISO D.M.D., PA

MEDICARE: RICHARD INTISO D.M.D., PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDENTAL 3564ME

General Provider Information

NPI Number : 1417074733
Entity Type Code : Organization
Provider Name (Legal Business Name) : RICHARD INTISO D.M.D., PA
Provider Business Mailing Address
First Line : 4 COMMONS AVE STE 2
Second Line :
City : WINDHAM
State : ME
Zip : 04062-5554
Country : US
Telephone Number : 207-893-2001
Fax Number : 207-893-2006
Provider Business Practice Location Address
First Line : 4 COMMONS AVE STE 2
Second Line :
City : WINDHAM
State : ME
Zip : 04062-5554
Country : US
Telephone Number : 207-893-2001
Fax Number : 207-893-2006
Authorized Official
Title or Position : DENTIST
Name : DR. RICHARD M INTISO
Credential : DMD
Telephone Number : 207-893-2001
Provider Enumeration Date : 03/23/2007
Last Update Date : 08/22/2020

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