# MAINEHEALTH

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MMC Oral Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073702288
- **Authorized official:** LUGENE ANTHONY INZANA (ASSOCIATE CFO)
- **Authorized official phone:** (207) 662-3538

## Contact information

- **Practice address:** 22 BRAMHALL ST, PORTLAND, ME 04102-3134
- **Practice address phone:** (207) 871-4078
- **Mailing address:** 301 US ROUTE 1, BUILDING C, SCARBOROUGH, ME 04074-7609
- **Mailing address phone:** (207) 396-8600
- **Mailing address fax:** (207) 396-8632

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | Yes |

## Other

- **Enumeration date:** 10/24/2007
- **Last updated:** 03/31/2025