Jeffrey Emanuel Dettori, DDS
Individual provider Active NPI General Practice Dentistry · Auburn, ME
NPI 1194931998 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1194931998
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 3478 (ME)
- Practice address
- 155 Center St
BLDG D 9
Auburn, ME 04210 - Phone
- (207) 783-2521
- Fax
- (207) 783-3150
- NPI assigned
- May 16, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160120002565 | ME | Order and Referring Only - Oral Surgery |
2961705280 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3478 | ME | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riverview Dental Associates | General Practice | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3478 | ME | Yes |
Addresses
Primary practice location
155 Center St
BLDG D 9
Auburn, ME 04210
Mailing address
PO Box 742
Auburn, ME 04212-0742
Phone (207) 576-6338
Other providers in Auburn, ME
- Dawn Ennis Decotiis
- Michael Joseph Defrance
- Robert L Descoteaux Jr.
- Nicole Denise Desjardins
- Michaela Despins
- Bruce H Dick
- Amanda Diffin
- Dirigo Support Professionals LLC
- Michael S Dixon
- Sandra Doctoroff
All providers in Auburn, ME · General Practice Dentistry 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.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.