Healthcare Provider Details

I. General information

NPI: 1528293735
Provider Name (Legal Business Name): KAYLA ANN PARENT RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 05/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CUMBERLAND PL SUITE 116
BANGOR ME
04401-5083
US

IV. Provider business mailing address

1 CUMBERLAND PL SUITE 116
BANGOR ME
04401-5083
US

V. Phone/Fax

Practice location:
  • Phone: 207-945-3360
  • Fax: 207-945-3361
Mailing address:
  • Phone: 207-945-3360
  • Fax: 207-945-3361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH3570
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: