INTERDENT LLC (NPI# 1992099311) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992099311 |
| Entity Type | Organization |
| Organization Name | INTERDENT LLC |
| Practice Address |
12 Shuman Ave Augusta ME 04330-6020 |
| Practice Telephone | 2076237580 |
| Mailing Telephone | 2076237580 |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2011-06-02 |
| Authorized Official Name | DR. GLEN FREDERIC ABBOTT II (PRESIDENT) |
| Authorized Official Telephone | 2077769776 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 3757 | ME | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ME | MAINE CARE | 435721099 | 01 |
| Street Address |
12 SHUMAN AVE |
| City | AUGUSTA |
| State | ME |
| Zip Code | 04330-6020 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083687024 | Jarrod John Henry | Physician Assistant | 12 Shuman Ave, Augusta, ME 04330-6020 | 2006-02-09 |
| 1700434248 | Paxton Marie Arsenault | Occupational Therapist | 12 Shuman Ave, Augusta, ME 04330-6020 | 2019-08-28 |
| 1790279560 | Jennifer Byron | Occupational Therapy Assistant | 12 Shuman Ave, Augusta, ME 04330-6020 | 2018-06-15 |
| 1558806877 | Betsy Allison Noyes | Occupational Therapy Assistant | 12 Shuman Ave, Suite 18, Augusta, ME 04330-6020 | 2016-12-21 |
| 1720433675 | Hayley Norberto | Occupational Therapist | 12 Shuman Ave, Augusta, ME 04330-6020 | 2016-04-28 |
| 1669878872 | Regional Home Care Inc | Durable Medical Equipment & Medical Supplies | 12 Shuman Ave, Unit #a-10, Augusta, ME 04330-6020 | 2014-11-16 |
| 1912331448 | Anita Pike | Occupational Therapy Assistant | 12 Shuman Ave, Augusta, ME 04330-6020 | 2013-09-03 |
| 1730396227 | Ellen Rudge Bowman | Counselor | 12 Shuman Ave, Suite 18, Augusta, ME 04330-6020 | 2007-05-16 |
| 1679669931 | Ann Davina Tuddenham | Pediatrics | 12 Shuman Ave, Augusta, ME 04330-6020 | 2006-10-05 |
| 1073615290 | Valerie Denise Gallagher | Audiologist | 12 Shuman Ave, Augusta, ME 04330-6020 | 2006-09-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770181877 | Renewal Family Center, LLC | Community/Behavioral Health | 10 Learners Drive, Augusta, ME 04330 | 2020-10-12 |
| 1134748759 | Chelsea Simone Koch | Registered Nurse | 1 Va Center, Department of Veterans Affairs, Augusta, ME 04330 | 2020-04-14 |
| 1790238442 | Nicole Lacrosse | Behavioral Analyst | 53 Hayden Rd, Augusta, ME 04330 | 2016-07-29 |
| 1093176844 | Richard J. Larrabee | Counselor | 312 Townhouse Road, Chelsea, ME 04330 | 2016-03-08 |
| 1376910984 | Sarah C. A. Tatlock | Social Worker | 41 Anthony Ave, Augusta, ME 04330 | 2015-08-31 |
| 1457728180 | Va Maine Health | General Acute Care Hospital | 1 Va Center 05, Va Maine Healthcare System-togus, Augusta, ME 04330 | 2015-08-28 |
| 1043696842 | Megan Arsenault | Pharmacist | 403 Water Street, Augusta, ME 04330 | 2015-08-04 |
| 1205219987 | Trevor Holbert | Audiologist | 1 Va Center - Togus Va Medical Center, Audiology 126a, Augusta, ME 04330 | 2015-06-30 |
| 1659787836 | Hannah M. Pullen | Occupational Therapy Assistant | 12 Shuman Ave Ste 16, Augusta, ME 04330 | 2014-07-08 |
| 1831469899 | Tanya Bernadette Quarterman | Specialist | 153 Hospital St Ste 13, Augusta, ME 04330 | 2012-01-09 |
| Find all providers in zip 04330 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417444167 | Victor Celis | Dentist | John Wesley Gilbert Dr, Augusta, GA 30912 | 2018-04-18 |
| 1356848022 | Olubusola Olaoluwa Olaseinde | Dentist | 2122 Swindon Dr, Augusta, GA 30909-6912 | 2018-04-10 |
| 1992172407 | Jeremy Richard Edwards | Dentist | 3208 Crane Ferry Rd, Augusta, GA 30907-3771 | 2015-09-01 |
| 1346616810 | Michael Shane Baura | Dentist | 1 Freedom Way # 233u, Augusta, GA 30904-6258 | 2015-08-19 |
| 1972912301 | Matthew Lee Andrews | Dentist | The Dental College of Georgia 1120 15th Street Gc 5110, Augusta, GA 30912-0001 | 2014-08-11 |
| 1962810358 | Fatemeh Azadeh Paziraei | Dentist | 1631 Gordon Highway, Augusta Smiles Youth Dentistry, Augusta, GA 30906 | 2014-07-29 |
| 1558797761 | One Smile Away Inc | Dentist | 4159 Elders Dr, Augusta, GA 30909-9145 | 2013-09-19 |
| 1285986067 | Tanya Lynn Shores | Dentist | 1210 Geore C. Wilson Dr., Augusta, GA 30909-4501 | 2012-10-04 |
| 1073864963 | Matthew Ross Anderson | Dentist | 1120 15th St # Gc5110, Augusta, GA 30912-0004 | 2012-10-02 |
| 1699099853 | Eric J Sterett | Dentist | 2437 Lumpkin Rd, Augusta, GA 30906-3000 | 2010-03-17 |
| Find all providers in AUGUSTA | ||||
Please comment or provide details below to improve the information on INTERDENT LLC.
| 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.