207 Periodontics, PLLC
Dentist, Periodontics in Portland, ME. Organization (NPI-2).
NPI number1629724877
StatusActive
Last updated in NPPESFeb 25, 2022
Details
- NPI
- 1629724877
- Entity type
- Organization (NPI-2)
- Legal business name
- 207 Periodontics, PLLC
- Organization subpart
- No
- Enumeration date
- Feb 25, 2022
- Certification date
- Feb 25, 2022
- Last updated
- Feb 25, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0300X | Dentist, Periodontics | – | – | Yes |
Practice location
595 Brighton AvePortland, ME 04102-2322
Phone 207-774-1471 · Fax 207-774-1472
Mailing address
595 Brighton AvePortland, ME 04102-2322
Phone 207-774-1471 · Fax 207-774-1472
Authorized official
Kara Achille
Owner Dentist
2077741471
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