NPIMap

Organization Active NPI

Community Dental

  • Dentist
  • Portland, ME
National Provider Identifier
1467528851
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
COMMUNITY DENTAL
Practice address
190 Park Ave
Portland, ME 04102-2910
Phone
(207) 874-1028
Fax
(207) 842-2963
NPI assigned
Nov 28, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY DENTALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Shelley Pelkey
Title
It Coordinator
Phone
(207) 874-1025

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

190 Park Ave
Portland, ME 04102-2910

Mailing address

190 Park Ave
Portland, ME 04102-2910
Phone (207) 874-1028

Other identifiers 1

IdentifierTypeStateIssuer
167870000MedicaidME

National Provider Directory

National Provider Directory
Tax ID family
Community Dental8 organizations share this tax ID, including this one
Part of
Community Dental

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1467528851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 PARK AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022910",
            "telephone_number": "207-874-1028",
            "fax_number": "207-842-2963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 PARK AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022910",
            "telephone_number": "207-874-1028",
            "fax_number": "207-842-2963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY DENTAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY DENTAL",
        "enumeration_date": "2006-11-28",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PELKEY",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_title_or_position": "IT COORDINATOR",
        "authorized_official_telephone_number": "207-874-1025"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167870000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.