Northeast Oral & Maxillofacial Surgery Associates P.a.

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

3079 Issued in ME

Legal business name

NORTHEAST ORAL & MAXILLOFACIAL SURGERY ASSOCIATES P.A.

Practice address

37 Bower St
Bangor, ME 04401-4721

Phone

(207) 945-5691

Fax

(207) 942-9525

NPI assigned

Feb 15, 2007

Organization subpart

No

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

Authorized official

Name

Dr. William A. Deighan, D.M.D.

Title

Co-Owner/Surgeon

Phone

(207) 945-5691

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Northeast Oral & Maxillofacial Surgery P.A.(remove) Other name

Locations

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355702400000",
    "number": "1255474698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 BOWER ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014721",
            "telephone_number": "207-945-5691",
            "fax_number": "207-942-9525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 BOWER ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014721",
            "telephone_number": "207-945-5691",
            "fax_number": "207-942-9525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST ORAL & MAXILLOFACIAL SURGERY ASSOCIATES P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2012-12-17",
        "status": "A",
        "authorized_official_last_name": "DEIGHAN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CO-OWNER/SURGEON",
        "authorized_official_telephone_number": "207-945-5691",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "ME",
            "license": "3079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "246780099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northeast Oral & Maxillofacial Surgery P.A.(remove)",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Oral and Maxillofacial Pathology Dentistry in Bangor, ME
• Providers in Bangor, ME by specialty
• Oral and Maxillofacial Pathology Dentistry in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2012; 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.