Brendan Hallissey

Primary specialty

DentistTaxonomy code 122300000X

License

3815 Issued in ME

Practice address

12 Newmarch St.
Kittery, ME 03904

Phone

(207) 439-3390

Fax

(207) 439-9006

NPI assigned

Nov 2, 2006

Last updated

Oct 17, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Downeast Center for Restorative Dentistry

  • Dentist
  • Kittery, ME
  • NPI 1568709772
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381968000000",
    "number": "1003995192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 NEWMARCH ST.",
            "city": "KITTERY",
            "state": "ME",
            "postal_code": "03904",
            "telephone_number": "207-439-3390",
            "fax_number": "207-439-9006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 NEWMARCH ST.",
            "city": "KITTERY",
            "state": "ME",
            "postal_code": "03904",
            "telephone_number": "207-439-3390",
            "fax_number": "207-439-9006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLISSEY",
        "first_name": "BRENDAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2013-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ME",
            "license": "3815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark William Governo, D.M.D
• Jeffrey Graffam, DMD
• Janet L Gray, PTA
• Mark F. Graziano, MD
• Meghan Grovo
• Elizabeth Ann Hammer, AU.D
• Lawrence Hankin, MD
• Kevin F Hardiman, PSYD
• Karen D Healy, O.D.
• Laura Jane Henckler, LCSW

• Dentist in Kittery, ME
• Providers in Kittery, ME by specialty
• Dentist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.