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22 Bramhall St Portland ME 04102-3134 | |
| (207) 871-4078 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Oral & Maxillofacial Surgery |
| Location | 22 Bramhall St, Portland, Maine |
| Authorized Official Name and Position | Lugene Anthony Inzana (ASSOCIATE CFO) |
| Authorized Official Contact | 2076623538 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
301 Us Route 1 Building C Scarborough ME 04074-7609 Ph: (207) 396-8600 | 22 Bramhall St Portland ME 04102-3134 Ph: (207) 871-4078 |
| NPI Number | 1073702288 |
|---|---|
| Provider Enumeration Date | 10/24/2007 |
| Last Update Date | 05/11/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073702288 | NPI | - | NPPES |
| 119910022 | Medicaid | ME |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Secondary |
| 204E00000X | Oral & Maxillofacial Surgery | (* (Not Available)) | Primary |
Md Portland Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 15 Middle St # A-c2, Portland, ME 04101 Phone: 207-307-1793 | |
Juno Dental Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1036 Brighton Ave Ste A, Portland, ME 04102 Phone: 207-773-2150 | |
Aspen Dental Of Maine Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1036 Brighton Ave, Portland, ME 04102 Phone: 207-773-2150 | |
Arc Dental Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 612 Brighton Ave, Portland, ME 04102 Phone: 207-772-4359 | |