Active NPI
Jeffrey Raymond Walawender, DDS
- Dentist
- Portland, ME
National Provider Identifier
1558676056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4153
- Practice address
- 640 Brighton Ave
Portland, ME 04102-1047 - Phone
- (207) 874-1028
- NPI assigned
- Aug 10, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4153 | ME | Primary |
Addresses
Primary practice location
640 Brighton Ave
Portland, ME 04102-1047
Mailing address
276 Canco Rd
Portland, ME 04103-4351
Phone (207) 874-1025
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4153 | ME | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1281398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1281398400000",
"number": "1558676056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "276 CANCO RD",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041034351",
"telephone_number": "207-874-1025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "640 BRIGHTON AVE",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041021047",
"telephone_number": "207-874-1028"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALAWENDER",
"first_name": "JEFFREY",
"middle_name": "RAYMOND",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-08-10",
"last_updated": "2010-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "ME",
"license": "4153",
"primary": true
}
],
"identifiers": [],
"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 Aug 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.