Provider Demographics
NPI:1588078505
Name:ANDROSCOGGIN ORTHODONTICS, P.A.
Entity type:Organization
Organization Name:ANDROSCOGGIN ORTHODONTICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-784-8587
Mailing Address - Street 1:1 WILLOW RUN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-8501
Mailing Address - Country:US
Mailing Address - Phone:207-784-8587
Mailing Address - Fax:207-777-5251
Practice Address - Street 1:1 WILLOW RUN
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-8501
Practice Address - Country:US
Practice Address - Phone:207-784-8587
Practice Address - Fax:207-777-5251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4352261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental