Healthcare Provider Details

I. General information

NPI: 1043136849
Provider Name (Legal Business Name): AMANDA ROMERO IPDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MIDDLE ST
AUGUSTA ME
04330-5229
US

IV. Provider business mailing address

6 LESTER DR
PORTLAND ME
04103-1614
US

V. Phone/Fax

Practice location:
  • Phone: 207-560-9200
  • Fax:
Mailing address:
  • Phone: 207-560-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH3874
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: