1447254057 NPI number — MR. ROBERT R. DENTON PT

Table of content: DR. GREGORY RAMIREZ DMD (NPI 1790341048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447254057 NPI number — MR. ROBERT R. DENTON PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENTON
Provider First Name:
ROBERT
Provider Middle Name:
R.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447254057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 FOREST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04103-1884
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-878-2244
Provider Business Mailing Address Fax Number:
207-878-5548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 FOREST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04103-1884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-878-2244
Provider Business Practice Location Address Fax Number:
207-878-5548
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT 821 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 027296 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 650015984 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001377970 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 131760199 . This is a "MAINE CARE (BOX 24)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1040915 . This is a "AETNA (REF)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1042586 . This is a "AETNA (BILLING)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 131760000 . This is a "MAINE CARE (BOX 33)" identifier . This identifiers is of the category "OTHER".
  • Identifier: A-135870 . This is a "HEALTH EOS" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA15471 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6627796 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: A-135870 . This is a "MULTI PLAN" identifier . This identifiers is of the category "OTHER".




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