Organization
COMMUNITY DENTAL
Active
Parent organization
COMMUNITY DENTAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY DENTAL
Authorized official
SHELLEY PELKEY (IT COORDINATOR)
(207) 874-1025
Entity
Organization
Contact information
Practice address
190 PARK AVE, PORTLAND, ME 04102-2910
(207) 874-1028
(207) 842-2963
Mailing address
190 PARK AVE, PORTLAND, ME 04102-2910
(207) 874-1028
(207) 842-2963
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167870000
—
ME
Enumeration date
11/28/2006
Last updated
07/21/2022
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