Michael Bennett, DMD – Dentist in Portland, ME

Key facts

NPI: 1104984970
Entity type: Individual (NPI type 1)
Primary specialty: Dentist 122300000X
License: 3523 (ME)
Practice address: 276 Canco Rd
Portland, ME 04103-4351
Phone: (207) 874-1025
NPI assigned: Dec 5, 2006
Sex: Male
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
3523	ME	MD	Dentist

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dentist	122300000X	3523	ME	Yes

Addresses

Primary practice location

276 Canco Rd
Portland, ME 04103-4351

Mailing address

276 Canco Rd
Portland, ME 04103-4351
Phone (207) 874-1025

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104984970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "276 CANCO RD",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041034351",
            "telephone_number": "207-874-1025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "276 CANCO RD",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041034351",
            "telephone_number": "207-874-1025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "MICHAEL",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ME",
            "license": "3523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

All providers in Portland, ME · Dentist in Maine

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.