Provider Demographics
NPI:1114129756
Name:CENTRAL MAINE ENDODONTICS
Entity type:Organization
Organization Name:CENTRAL MAINE ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAZUR KARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MPH
Authorized Official - Phone:207-783-1671
Mailing Address - Street 1:219 MOUNT AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210
Mailing Address - Country:US
Mailing Address - Phone:207-783-1671
Mailing Address - Fax:207-783-3717
Practice Address - Street 1:219 MOUNT AUBURN AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210
Practice Address - Country:US
Practice Address - Phone:207-783-1671
Practice Address - Fax:207-783-3717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME31701223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty