Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 3720 | ME |
NPI | 1043200868 |
---|---|
Provider Name | Gregory V Sarka |
First Address | Waterville, ME 04901-4538 |
Second Address | Waterville, ME 04901-4538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 16/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I10573 | (02) | |
ME0736 | MEDICARE (01) | ME |