MAINELY KIDS & TEENS, LLC (NPI# 1467835678) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467835678 |
| Entity Type | Organization |
| Organization Name | MAINELY KIDS & TEENS, LLC |
| Other Organization Name | BANGOR CHILDREN'S DENTISTRY |
| Practice Address |
One Cumberland Pl Ste 116 Bangor ME 04401-5083 |
| Practice Telephone | 2079743018 |
| Mailing Telephone | 2079743018 |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2015-11-23 |
| Authorized Official Name | DR. MARCUS ALLEN WILKERSON (CEO) |
| Authorized Official Telephone | 2079510225 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
DEN4448 | ME | Dental Providers |
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
DEN4256 | ME | Dental Providers |
| Other Name | Type Code |
|---|---|
| Bangor Children's Dentistry | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801433750 | Mainely Kids & Teens, LLC | Dentist | 8 Shuman Ave, Augusta, ME 04330-7751 | 2019-12-10 |
| Street Address |
ONE CUMBERLAND PL STE 116 |
| City | BANGOR |
| State | ME |
| Zip Code | 04401-5083 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184222523 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 110 Longview Dr, Bangor, ME 04401 | 2020-10-16 |
| 1033737937 | Daniel John Phulman | Counselor | 202 Exchange Street, Bangor, ME 04401 | 2020-07-08 |
| 1770104358 | Elizabeth Sarah Caruson | Physician Assistant | 417 State Street Webber Medical Building, East St, Ste. 121, Bangor, ME 04401 | 2020-05-05 |
| 1053961300 | Erika Dean | Occupational Therapist | 84 Sylvan Rd., Bangor, ME 04401 | 2019-09-18 |
| 1942853635 | Wildworks Therapy, Pllc | Occupational Therapist | 123 Mt Hope Ave, Bangor, ME 04401 | 2019-07-22 |
| 1255999173 | Jessica Arbisi | Physician Assistant | 1 Northeast Drive, Bangor, ME 04401 | 2019-06-05 |
| 1699232041 | Ehab Khamis Elhefnawi | Anesthesiology | Emmc Anesthesia Professional Service, 489 State Street, Bangor, ME 04401 | 2019-02-21 |
| 1477028884 | Zvorufura Makura | Otolaryngology | 885 Union Street, Ste 145, Bangor, ME 04401 | 2018-10-11 |
| 1255826541 | Lindsey M Fields | Optometrist | 955 Broadway Eye Center Northeast Dba Northeast Eyecare, Bangor, ME 04401 | 2018-06-28 |
| 1992211338 | Debra J Mcintyre | Counselor | 157 Park Street, #5, Bangor, ME 04401 | 2017-12-21 |
| Find all providers in zip 04401 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023131679 | Jonathan D Shenkin | Dentist | 792 Stillwater Ave, Bangor, ME 04401-3617 | 2007-04-09 |
| 1841380037 | Linda A Eberhardt | Dentist | 24 Penn Plaza, Bangor, ME 04401 | 2006-10-16 |
| 1194810143 | Sheila L Brijade | Dentist | 1048 Union Street, Bangor, ME 04401 | 2006-10-04 |
| 1679038137 | Katahdin Pediatric's Pa | Dentist | 24 Penn Plz, Bangor, ME 04401-3620 | 2019-02-08 |
| 1013274067 | Katahdin Pediatric Dentistry | Dentist | 24 Penn Plz, Bangor, ME 04401-3620 | 2012-04-16 |
| 1285854836 | Penobscot Childrens Dentistry Associates | Dentist | 792 Stillwater Ave, Bangor, ME 04401-3617 | 2007-04-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538632997 | Dirigo Pediatric Dentistry | Dentist | 701 Us Route 1 Ste 3, Yarmouth, ME 04096-6927 | 2019-01-09 |
| 1386931376 | Coastal Maine Pediatric Dentistry | Dentist | 84 Baribeau Dr, Brunswick, ME 04011-3218 | 2011-06-29 |
| 1225222698 | Emily B Scholl | Dentist | 80 Pleasant St, Brunswick, ME 04011-2203 | 2007-08-29 |
| 1366574675 | Just for Kids Pediatric Dentistry, Pa | Dentist | 313 Us Route 1, Scarborough, ME 04074-9701 | 2007-03-12 |
| 1902940364 | York County Pediartic Dentistry, Pa | Dentist | 5 Webhannet Pl, Suite 1, Kennebunk, ME 04043-7275 | 2007-02-19 |
| 1215093018 | John M Willis | Dentist | 6 Fundy Rd, Falmouth, ME 04105-1705 | 2006-12-28 |
| 1568485019 | Malcolm Stuart Foster | Dentist | 85 Baribeau Dr, Brunswick, ME 04011-3249 | 2006-07-25 |
| 1083650436 | Susan J Russett-collett | Dentist | 888 Brighton Ave, Portland, ME 04102-1004 | 2006-06-22 |
| 1801433750 | Mainely Kids & Teens, LLC | Dentist | 8 Shuman Ave, Augusta, ME 04330-7751 | 2019-12-10 |
| 1245737832 | Chelsea Johnston | Dentist | 300 Technology Way, Scarborough, ME 04074-7654 | 2018-04-10 |
| Find all providers with the same taxonomy | ||||
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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.