1841691631 NPI number — WHITE MOUNTAIN ORTHODONTICS, PA

Table of content: DR. WALTER RUSSELL OWENS III D.D.S. (NPI 1356535876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841691631 NPI number — WHITE MOUNTAIN ORTHODONTICS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE MOUNTAIN ORTHODONTICS, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1841691631
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 850
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCARBOROUGH
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04070-0850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
713 ROOSEVELT TRAIL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-894-8700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2014

Additional Information

Authorized Official

Authorized Official Last Name:
RANKIE
Authorized Official First Name:
BURTON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
207-894-8700

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  DEN 4239 , 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)





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