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650 Brighton Ave Portland ME 04102-1035 | |
| (207) 773-6331 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 650 Brighton Ave, Portland, Maine |
| Authorized Official Name and Position | Michael Angelo Scialabba (CHIEF CLINICAL OFFICER) |
| Authorized Official Contact | 7816470772 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
650 Brighton Ave Portland ME 04102-1035 Ph: (207) 773-6331 | 650 Brighton Ave Portland ME 04102-1035 Ph: (207) 773-6331 |
| NPI Number | 1528130283 |
|---|---|
| Provider Enumeration Date | 11/15/2006 |
| Last Update Date | 12/29/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528130283 | NPI | - | NPPES |
| 329670099 | Medicaid | ME | |
| 251480099 | Medicaid | ME | |
| 315660099 | Medicaid | ME |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2954 (Maine) | Primary |
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