Individual
JEFFREY RAYMOND WALAWENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
640 BRIGHTON AVE, PORTLAND, ME 04102-1047
(207) 874-1028
Mailing address
276 CANCO RD, PORTLAND, ME 04103-4351
(207) 874-1025
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4153
ME
Other
Enumeration date
08/10/2010
Last updated
08/10/2010
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