Provider Demographics
NPI:1427472398
Name:MAINE ENDODONTICS PA
Entity type:Organization
Organization Name:MAINE ENDODONTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:PAGE
Authorized Official - Last Name:WYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-622-2500
Mailing Address - Street 1:221 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5930
Mailing Address - Country:US
Mailing Address - Phone:207-622-2500
Mailing Address - Fax:207-623-3077
Practice Address - Street 1:221 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5930
Practice Address - Country:US
Practice Address - Phone:207-622-2500
Practice Address - Fax:207-623-3077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME26711223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty