Montressor Lamar Upshaw, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DEN4484 Issued in ME

Practice address

1048 Union St
Penobscot Community Health Center
Bangor, ME 04401-3016

Phone

(207) 992-2152

NPI assigned

Jul 14, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1247529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468972800000",
    "number": "1295965036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1599",
            "address_2": "PENOBSCOT COMMUNITY HEALTH CENTER",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021599",
            "telephone_number": "207-945-5247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1048 UNION ST",
            "address_2": "PENOBSCOT COMMUNITY HEALTH CENTER",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013016",
            "telephone_number": "207-992-2152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UPSHAW",
        "first_name": "MONTRESSOR",
        "middle_name": "LAMAR",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-14",
        "last_updated": "2016-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ME",
            "license": "DEN4484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2016; 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.