Active NPI
Bruce Joy Podhouser, DMD ABO
- Dentist
- South Portland, ME
National Provider Identifier
1619901857
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 3405
- Practice address
- 440 Western Ave
South Portland, ME 04106 - Phone
- (207) 772-5487
- Fax
- (207) 772-7553
- NPI assigned
- Jul 11, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3405 | ME | Primary |
| Dentist | 122300000X | 3772 | NH |
Addresses
Primary practice location
440 Western Ave
South Portland, ME 04106
Mailing address
84 Rosewood Drive
Raymond, ME 04071
Phone (207) 627-9927
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 |
|---|---|---|---|
| 3405 | ME | MD | Dentist |
| 3772 | NH | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619901857",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "84 ROSEWOOD DRIVE",
"city": "RAYMOND",
"state": "ME",
"postal_code": "04071",
"telephone_number": "207-627-9927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "440 WESTERN AVE",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "04106",
"telephone_number": "207-772-5487",
"fax_number": "207-772-7553"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PODHOUSER",
"first_name": "BRUCE",
"middle_name": "JOY",
"name_prefix": "Dr.",
"credential": "DMD ABO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "ME",
"license": "3405",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NH",
"license": "3772",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.