NPIMap

Organization Active NPI

Dental Specialists of Maine, LLC

  • Endodontics
  • Portland, ME
National Provider Identifier
1811197601
Registry record updated Apr 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
3810 Issued in ME
Legal business name
DENTAL SPECIALISTS OF MAINE, LLC
Practice address
1355 Congress St Ste a
Portland, ME 04102-2137
Phone
(207) 879-0010
Fax
(207) 879-0011
NPI assigned
Jul 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2013

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

Authorized official

Name
Miss Jared Boudreau, MBA, MSA
Title
Practice Director
Phone
(207) 879-0010

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223E0200X 3810 ME Primary
EndodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223E0200X 4027 ME

Addresses

Primary practice location

1355 Congress St Ste a
Portland, ME 04102-2137

Mailing address

1355 Congress St Ste a
Portland, ME 04102-2137
Phone (207) 879-0010

National Provider Directory

National Provider Directory
Tax ID family
Dental Specialists of Yarmouth LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

1355 Congress St
Ste A
Portland, ME 04102
Phone (207) 879-0010

NPI Registry JSON

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

{
    "created_epoch": "1184889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364774400000",
    "number": "1811197601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 CONGRESS ST STE A",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022137",
            "telephone_number": "207-879-0010",
            "fax_number": "207-879-0011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 CONGRESS ST STE A",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022137",
            "telephone_number": "207-879-0010",
            "fax_number": "207-879-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL SPECIALISTS OF MAINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-20",
        "last_updated": "2013-04-01",
        "status": "A",
        "authorized_official_last_name": "BOUDREAU",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "PRACTICE DIRECTOR",
        "authorized_official_telephone_number": "207-879-0010",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "MBA, MSA"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "ME",
            "license": "3810",
            "primary": true
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "ME",
            "license": "4027",
            "primary": false
        }
    ],
    "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 Apr 1, 2013; 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.