Provider Demographics
NPI:1417979386
Name:ACKERMAN, JOEL FREDERICK (DMD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:FREDERICK
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PARCHER STREET
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1627
Mailing Address - Country:US
Mailing Address - Phone:207-667-8124
Mailing Address - Fax:
Practice Address - Street 1:99 OAK STREET
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605
Practice Address - Country:US
Practice Address - Phone:507-667-3009
Practice Address - Fax:507-667-3000
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME26571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice