Organization
BANGOR FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK L CARREIRA D.M.D., D.D.S. (OWNER)
(207) 947-4767
Entity
Organization
Contact information
Practice address
83 RIDGEWOOD DR, BANGOR, ME 04401-2652
(207) 947-4767
(207) 947-7112
Mailing address
83 RIDGEWOOD DR, BANGOR, ME 04401-2652
(207) 947-4767
(207) 947-7112
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2098
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104880000
—
ME
01
—
828257
UNITED CONCORDIA
ME
Enumeration date
08/07/2006
Last updated
05/04/2018
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