Healthcare Provider Details

I. General information

NPI: 1255264958
Provider Name (Legal Business Name): MARISSA ABBOTT RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 DIRIGO DR
BREWER ME
04412-1662
US

IV. Provider business mailing address

24 DIRIGO DR
BREWER ME
04412-1662
US

V. Phone/Fax

Practice location:
  • Phone: 207-307-7405
  • Fax: 207-307-7490
Mailing address:
  • Phone: 207-307-7405
  • Fax: 207-307-7490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH4738
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: