| Coastal Family Dental P.a. | |
|
110 Auburn Street Portland ME 04103 | |
| (207) 797-7433 | |
| (207) 797-7720 |
| Full Name | Coastal Family Dental P.a. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 110 Auburn Street, Portland, Maine |
| Authorized Official Name and Position | Alan Jesse Chebuske (OWNER/BILLING ENTITY) |
| Authorized Official Contact | 2077977433 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Family Dental P.a. 110 Auburn Street Portland ME 04103 Ph: (207) 797-7433 | Coastal Family Dental P.a. 110 Auburn Street Portland ME 04103 Ph: (207) 797-7433 |
| NPI Number | 1154446672 |
|---|---|
| Provider Enumeration Date | 03/21/2007 |
| Last Update Date | 11/30/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154446672 | NPI | - | NPPES |
| 124010000 | Medicaid | ME |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 3047 (Maine) | Primary |
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