Interdent LLC

Primary specialty

DentistTaxonomy code 122300000X

License

3757 Issued in ME

Legal business name

INTERDENT LLC

Practice address

12 Shuman Ave
Augusta, ME 04330-6020

Phone

(207) 623-7580

NPI assigned

Jun 2, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Glen Frederic Abbott II, D.D.S.

Title

President

Phone

(207) 776-9776

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1306972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306972800000",
    "number": "1992099311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 SHUMAN AVE",
            "city": "AUGUSTA",
            "state": "ME",
            "postal_code": "043306020",
            "telephone_number": "207-623-7580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 SHUMAN AVE",
            "city": "AUGUSTA",
            "state": "ME",
            "postal_code": "043306020",
            "telephone_number": "207-623-7580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERDENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-02",
        "last_updated": "2011-06-02",
        "status": "A",
        "authorized_official_last_name": "ABBOTT",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "FREDERIC",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "207-776-9776",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "ME",
            "license": "3757",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAINE CARE",
            "identifier": "435721099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2011; 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.