NPIMap

Organization Active NPI

Bangor Family Dentistry

  • General Practice Dentistry
  • Bangor, ME
National Provider Identifier
1457360562
Registry record updated May 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2098 Issued in ME
Legal business name
BANGOR FAMILY DENTISTRY
Practice address
83 Ridgewood Dr
Bangor, ME 04401-2652
Phone
(207) 947-4767
Fax
(207) 947-7112
NPI assigned
Aug 7, 2006
Last updated
May 4, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2018

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

Authorized official

Name
Dr. Mark L Carreira, D.M.D., D.D.S.NPI 1235365644
Title
Owner
Phone
(207) 947-4767

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 2098 ME Primary

Addresses

Primary practice location

83 Ridgewood Dr
Bangor, ME 04401-2652

Mailing address

83 Ridgewood Dr
Bangor, ME 04401-2652
Phone (207) 947-4767

Other identifiers 2

IdentifierTypeStateIssuer
104880000MedicaidME
828257OtherMEUNITED CONCORDIA

National Provider Directory

National Provider Directory

Locations

83 Ridgewood Dr
Bangor, ME 04401
Phone (207) 947-4767

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525392000000",
    "number": "1457360562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "83 RIDGEWOOD DR",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044012652",
            "telephone_number": "207-947-4767",
            "fax_number": "207-947-7112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "83 RIDGEWOOD DR",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044012652",
            "telephone_number": "207-947-4767",
            "fax_number": "207-947-7112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANGOR FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-07",
        "last_updated": "2018-05-04",
        "status": "A",
        "authorized_official_last_name": "CARREIRA",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-947-4767",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D., D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ME",
            "license": "2098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104880000",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "828257",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2018; 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.