Healthcare Provider Details

I. General information

NPI: 1760789044
Provider Name (Legal Business Name): BRIDGTON DENTAL HYGIENE CARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171-B PORTLAND RD.
BRIDGTON ME
04009-4210
US

IV. Provider business mailing address

171-B PORTLAND RD.
BRIDGTON ME
04009-4210
US

V. Phone/Fax

Practice location:
  • Phone: 207-647-4125
  • Fax: 207-647-4126
Mailing address:
  • Phone: 207-647-4125
  • Fax: 207-647-4126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberIPDH8
License Number StateME

VIII. Authorized Official

Name: CATHERINE J. KASPRAK
Title or Position: PRESIDENT, OWNER
Credential: RDH, IPDH
Phone: 207-647-4125