| Greater Portland Endodontics Pa | |
|
1330 Congress St Portland ME 04102-2144 | |
| (207) 879-0010 | |
| Not Available |
| Full Name | Greater Portland Endodontics Pa |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 1330 Congress St, Portland, Maine |
| Authorized Official Name and Position | Daniel C Fackrell (ENDODONTIST) |
| Authorized Official Contact | 2078790010 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Greater Portland Endodontics Pa 9 Holly Dr Cumberland ME 04021-3950 Ph: (860) 716-6856 | Greater Portland Endodontics Pa 1330 Congress St Portland ME 04102-2144 Ph: (207) 879-0010 |
| NPI Number | 1316474802 |
|---|---|
| Provider Enumeration Date | 05/16/2017 |
| Last Update Date | 05/16/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316474802 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | 4291 (Maine) | Primary |
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