Provider Demographics
NPI:1306871405
Name:G.MICHAEL MAITRE DMD PA
Entity type:Organization
Organization Name:G.MICHAEL MAITRE DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MAITRE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-344-4571
Mailing Address - Street 1:801 UNIVERSITY BLVD S # A
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-2923
Mailing Address - Country:US
Mailing Address - Phone:251-344-4571
Mailing Address - Fax:251-344-2413
Practice Address - Street 1:801 UNIVERSITY BLVD S # A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2923
Practice Address - Country:US
Practice Address - Phone:251-344-4571
Practice Address - Fax:251-344-2413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL45291223G0001X
AL54121223G0001X
AL56891223G0001X
AL27231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-94272OtherBLUE CROSS BLUE SHIELD AL
AL515-32488OtherBLUE CROSS BLUE SHIELD AL
AL510-92383OtherBLUE CROSS BLUE SHILED AL