NPIMap

Organization Active NPI

Southern Maine Oral and Maxillofacial Surgery PA

  • Oral and Maxillofacial Surgery (Dentist)
  • South Portland, ME
National Provider Identifier
1831256338
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
SOUTHERN MAINE ORAL AND MAXILLOFACIAL SURGERY PA
Practice address
440 Western Avenue
South Portland, ME 04106
Phone
(207) 774-2611
Fax
(207) 774-2613
NPI assigned
Jan 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Richard W Crawford, DMDNPI 1174629794
Title
Owner
Phone
(207) 774-2611

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

440 Western Avenue
South Portland, ME 04106

Mailing address

440 Western Avenue
South Portland, ME 04106
Phone (207) 774-2611

National Provider Directory

National Provider Directory

Locations

131 Johnson Rd
Ste 3
Portland, ME 04102
Phone (207) 774-2611

12 Drive in Ln
Windham, ME 04062
Phone (207) 892-3100

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831256338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 WESTERN AVENUE",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "04106",
            "telephone_number": "207-774-2611",
            "fax_number": "207-774-2613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 WESTERN AVENUE",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "04106",
            "telephone_number": "207-774-2611",
            "fax_number": "207-774-2613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MAINE ORAL AND MAXILLOFACIAL SURGERY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CRAWFORD",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-774-2611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "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 Aug 22, 2020; 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.