GREATER PORTLAND ENDODONTICS PA (NPI# 1316474802) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316474802 |
| Entity Type | Organization |
| Organization Name | GREATER PORTLAND ENDODONTICS PA |
| Practice Address |
1330 Congress St Portland ME 04102-2144 |
| Mailing Address |
9 Holly Dr Cumberland ME 04021-3950 |
| Practice Telephone | 2078790010 |
| Mailing Telephone | 8607166856 |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2017-05-16 |
| Authorized Official Name | DR. DANIEL C FACKRELL (ENDODONTIST) |
| Authorized Official Telephone | 2078790010 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223E0200X |
Dentist Specialization: Endodontics |
4291 | ME | Dental Providers |
| Street Address |
1330 CONGRESS ST |
| City | PORTLAND |
| State | ME |
| Zip Code | 04102-2144 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548295520 | Richard Paul Lemieux | Dentist | 1330 Congress St, Portland, ME 04102-2144 | 2006-07-11 |
| 1497892475 | Richard P. Lemieux D.m.d., Pa | Dentist | 1330 Congress St, Portland, ME 04102-2144 | 2007-01-31 |
| 1316959513 | Daniel C Fackrell | Dentist | 1330 Congress St, Portland, ME 04102-2144 | 2006-08-13 |
| 1477588671 | Mark R Lebel Jr. | Dentist | 1330 Congress St, Portland, ME 04102-2144 | 2006-07-12 |
| 1750316956 | David D Nalchajian | Dentist | 1330 Congress St, Portland, ME 04102-2144 | 2006-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720602964 | Ci Yen Joanna Man | Student in an Organized Health Care Education/Training Program | 190 Park Ave., Portland, ME 04102 | 2020-06-03 |
| 1841811338 | Abby Zarotny Sahagian | Nurse Anesthetist, Certified Registered | Mmc Anesthesia and Perioperative Medicine, 22 Bramhall St, Portland, ME 04102 | 2020-05-06 |
| 1124656863 | Zachary Bernard Tillett | Student in an Organized Health Care Education/Training Program | Maine Medical Center 22 Bramhall St., Portland, ME 04102 | 2020-03-30 |
| 1215564323 | Joshua Allen Swenson | Student in an Organized Health Care Education/Training Program | 33 Bramhall St, Portland, ME 04102 | 2020-03-26 |
| 1740776434 | Rishi Phakey | Dentist | Community Dental, 190 Park Ave, Portland, ME 04102 | 2018-07-05 |
| 1982192571 | Jessica Thomas | Doula | 619 Brighton Ave #101, Rosemont Wellness Center, Portland, ME 04102 | 2018-04-29 |
| 1699270744 | Shane D Kirkegaard | Student in an Organized Health Care Education/Training Program | Maine Medical Center 22 Bramhall Street, Portland, ME 04102 | 2018-03-29 |
| 1144752494 | Al-shawk Home Healthcare, LLC | Technician | 640 Brighton Ave Ste 8, Portland, ME 04102 | 2017-03-28 |
| 1376074674 | Samuel B Potter | Emergency Medicine | Maine Medical Center, 22 Bramhall Street, Portland, ME 04102 | 2017-03-27 |
| 1043767536 | Kevin De Ruiter | Social Worker | 129 Pine St Apt 6, Portland, ME 04102 | 2016-09-01 |
| Find all providers in zip 04102 | ||||
| Taxonomy Code | 1223E0200X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Endodontics |
| The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396259040 | Scott L. Barry, Dmd, PC | Dentist | 9020 Sw Washington Square Rd Ste 570, Portland, OR 97223-4477 | 2017-11-16 |
| 1386084564 | Sonja R Evans | Dentist | 82 Coyle St, Portland, ME 04101-1628 | 2013-07-02 |
| 1770849838 | West Coast Endodontics, PC | Dentist | 9907 Se Division Street, Ste A, Portland, OR 87266 | 2012-04-03 |
| 1780868687 | Dental Specialists of Portland | Dentist | 1355 Congress St, Suite A, Portland, ME 04102-2160 | 2007-12-27 |
| 1811197601 | Dental Specialists of Maine, LLC | Dentist | 1355 Congress St Ste A, Portland, ME 04102-2137 | 2007-07-20 |
| 1437365889 | Jason A Garlock | Dentist | 276 Canco Road, Granite Heights, Portland, ME 04103 | 2007-05-15 |
| 1346467404 | Tony Bassili | Dentist | 11982 Ne Glisan St, Portland, OR 97220-2143 | 2007-04-19 |
| 1427029503 | Brooks Bradley Horan | Dentist | 405 Se 133rd Ave, Portland, OR 97233-1809 | 2006-01-27 |
| 1497749881 | Scott W Edgar | Dentist | 1020 Ne 2nd Ave, #320, Portland, OR 97232-2064 | 2005-08-31 |
| 1053312595 | Danielle Paige Wingrove | Dentist | 2730 Sw Moody Ave # 5n032, Portland, OR 97201 | 2005-08-09 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.