Penobscot Childrens Dentistry Associates

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

3649 Issued in ME

Legal business name

PENOBSCOT CHILDRENS DENTISTRY ASSOCIATES

Practice address

792 Stillwater Ave
Bangor, ME 04401-3617

Phone

(207) 947-6733

Fax

(207) 947-6760

NPI assigned

Apr 26, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jonathan David Shenkin, DDS

Title

Pediatric Dentist

Phone

(207) 947-6733

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285854836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "792 STILLWATER AVE",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013617",
            "telephone_number": "207-947-6733",
            "fax_number": "207-947-6760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "792 STILLWATER AVE",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013617",
            "telephone_number": "207-947-6733",
            "fax_number": "207-947-6760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENOBSCOT CHILDRENS DENTISTRY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHENKIN",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "207-947-6733",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "ME",
            "license": "3649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Peng, MD
• Monique Penney, NP
• Penobscot Area Housing Development Corporation
• Penobscot Area Housing Development Corporation
• Penobscot Area Housing Development Corporation
• Penobscot Community Health Care
• Penobscot Community Health Center (William S. Cohen School)
• Penobscot Community Health Center (Penobscot Community Dental Clinic)
• Penobscot Community Health Center (Adult Wellness Center)
• Penobscot Community Health Center (Hope House Health Center)

• Pediatric Dentistry in Bangor, ME
• Providers in Bangor, ME by specialty
• Pediatric Dentistry in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.