Organization
GREATER PORTLAND ENDODONTICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL C FACKRELL DMD (ENDODONTIST)
(207) 879-0010
Entity
Organization
Contact information
Practice address
1330 CONGRESS ST, PORTLAND, ME 04102-2144
(207) 879-0010
Mailing address
9 HOLLY DR, CUMBERLAND, ME 04021-3950
(860) 716-6856
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
4291
ME
Other
Enumeration date
05/16/2017
Last updated
05/16/2017
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