Provider Demographics
NPI:1487459210
Name:PEDIATRIC DENTISTRY ASLEEP OF MAINE
Entity type:Organization
Organization Name:PEDIATRIC DENTISTRY ASLEEP OF MAINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:WANA
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:857-200-3312
Mailing Address - Street 1:500 N LEWIS RUN RD STE 215A
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-3009
Mailing Address - Country:US
Mailing Address - Phone:857-200-3312
Mailing Address - Fax:
Practice Address - Street 1:55 SPRING ST
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8926
Practice Address - Country:US
Practice Address - Phone:857-200-3312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC DENTISTRY ASLEEP GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty