Greater Portland Endodontics PA

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

4291 Issued in ME

Legal business name

GREATER PORTLAND ENDODONTICS PA

Practice address

1330 Congress St
Portland, ME 04102-2144

Phone

(207) 879-0010

NPI assigned

May 16, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Daniel C Fackrell, DMD

Title

Endodontist

Phone

(207) 879-0010

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1494892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494892800000",
    "number": "1316474802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 HOLLY DR",
            "city": "CUMBERLAND",
            "state": "ME",
            "postal_code": "040213950",
            "telephone_number": "860-716-6856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 CONGRESS ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022144",
            "telephone_number": "207-879-0010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER PORTLAND ENDODONTICS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-16",
        "last_updated": "2017-05-16",
        "status": "A",
        "authorized_official_last_name": "FACKRELL",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "ENDODONTIST",
        "authorized_official_telephone_number": "207-879-0010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "ME",
            "license": "4291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassidy Grass
• Paul Grayce, D.O.
• Melissa Graziani, AU.D.
• Great Island Recovery
• Great Residential Home Care LLC
• Greater Portland Home Care, LLC
• David R Greatorex, M.D.
• Patricia Greatorex, M.D.
• Jennifer Warren Greaves, L.C.S.W., L.A.D.C.
• Callie Wells Greco, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2017; 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.