Individual
DR. G KENT TABLEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
766 STILLWATER AVE, BANGOR, ME 04401-3616
(207) 942-1442
(207) 942-1832
Mailing address
PO BOX 920, BANGOR, ME 04402-0920
(207) 942-1442
(207) 942-1832
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2535
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001735
ANTHEM PROVIDER NUMBER
ME
05
—
238580099
—
ME
01
—
812377
UNITED CONCORDIA PROV. NO
ME
Enumeration date
08/03/2006
Last updated
07/09/2007
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