Individual
JEFFREY S FISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1048 UNION ST, BANGOR, ME 04401-3016
(207) 404-8100
(207) 947-0435
Mailing address
PO BOX 1599, BANGOR, ME 04402-1599
(207) 404-8200
(207) 975-0435
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DEN2739
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115550000
—
ME
01
—
2739
STATE LICENSE
ME
Enumeration date
10/17/2006
Last updated
05/04/2021
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