Tamer George I Theodory, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

FDN23 Issued in ME

Practice address

University of New England College of Dental Medicine
716 Stevens Avenue
Portland, ME 04103

Phone

(207) 221-4863

NPI assigned

Sep 25, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1443139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656288000000",
    "number": "1124498779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF NEW ENGLAND COLLEGE OF DENTAL MEDICINE",
            "address_2": "716 STEVENS AVENUE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04103",
            "telephone_number": "207-221-4863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF NEW ENGLAND COLLEGE OF DENTAL MEDICINE",
            "address_2": "716 STEVENS AVENUE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04103",
            "telephone_number": "207-221-4863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEODORY",
        "first_name": "TAMER",
        "middle_name": "GEORGE I",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-25",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IA",
            "license": "30451",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ME",
            "license": "FDN23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.