Healthcare Provider Details

I. General information

NPI: 1952535304
Provider Name (Legal Business Name): JULIE GOSLINE BOLSTER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MERRILL ST
FARMINGDALE ME
04344-1622
US

IV. Provider business mailing address

189 OLD BRUNSWICK RD
GARDINER ME
04345-6038
US

V. Phone/Fax

Practice location:
  • Phone: 207-626-3091
  • Fax:
Mailing address:
  • Phone: 207-582-4939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2010
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: