Provider Demographics
NPI:1053908103
Name:MAINE PERIODONTICS PLLLC
Entity type:Organization
Organization Name:MAINE PERIODONTICS PLLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:H
Authorized Official - Last Name:GAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-632-3443
Mailing Address - Street 1:2 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9400
Mailing Address - Country:US
Mailing Address - Phone:207-283-4867
Mailing Address - Fax:207-283-4496
Practice Address - Street 1:2 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9400
Practice Address - Country:US
Practice Address - Phone:207-283-4867
Practice Address - Fax:207-283-4496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty