Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | MD23542 | ME |
NPI | 1083215404 |
---|---|
Provider Name | Ahmed Messahel |
First Address | Brewer, ME 04412-1006 |
Second Address | Bangor, ME 04441-6630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2020 |
Last Update Date | 17/12/2020 |