Healthcare Provider Details

I. General information

NPI: 1053721829
Provider Name (Legal Business Name): MEGHAN RIANNE PACKARD RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 05/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 CHRISTIAN RIDGE RD
ELLSWORTH ME
04605-3210
US

IV. Provider business mailing address

52 CHRISTIAN RIDGE RD
ELLSWORTH ME
04605-3210
US

V. Phone/Fax

Practice location:
  • Phone: 207-667-0293
  • Fax: 207-667-5805
Mailing address:
  • Phone: 207-667-0293
  • Fax: 207-667-5805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH3893
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: