Provider Demographics
NPI:1538632997
Name:DIRIGO PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:DIRIGO PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-251-0840
Mailing Address - Street 1:188 MILLIKEN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04097-6717
Mailing Address - Country:US
Mailing Address - Phone:207-251-0840
Mailing Address - Fax:
Practice Address - Street 1:701 US ROUTE 1 STE 3
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6927
Practice Address - Country:US
Practice Address - Phone:207-251-0840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty