Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 20170 1 | MA |
N | 1223X0400X | Orthodontists | 03555 | NH |
Y | 1223X0400X | Orthodontists | 3652 | ME |
NPI | 1063606606 |
---|---|
Provider Name | Dr. Corey J Teguis |
First Address | Biddeford, ME 04005 |
Second Address | Biddeford, ME 04005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 28/08/2007 |