MEDICARE: MRS. CHEANA MARIE HERBEST RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	RDH3679	ME

General Provider Information

NPI Number	:	1417258591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHEANA MARIE HERBEST RDH

Provider Business Mailing Address
First Line	:	337 MEDFORD RD
Second Line	:
City	:	MILO
State	:	ME
Zip	:	04463-1519
Country	:	US
Telephone Number	:	207-943-3903
Fax Number	:

Provider Business Practice Location Address
First Line	:	337 MEDFORD RD
Second Line	:
City	:	MILO
State	:	ME
Zip	:	04463-1519
Country	:	US
Telephone Number	:	207-943-3903
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2010
Last Update Date	:	11/05/2010

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