Provider Demographics
NPI:1588138804
Name:TURK, DALE JONATHAN
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:JONATHAN
Last Name:TURK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 OAK ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVALE
Mailing Address - State:ME
Mailing Address - Zip Code:04083-1927
Mailing Address - Country:US
Mailing Address - Phone:407-341-4929
Mailing Address - Fax:
Practice Address - Street 1:25 OAK ST
Practice Address - Street 2:
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083-1927
Practice Address - Country:US
Practice Address - Phone:407-341-4929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator