Healthcare Provider Details

I. General information

NPI: 1982913216
Provider Name (Legal Business Name): DONNA L POULIN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 CAMBELL SHORE RD
GRAY ME
04039-7770
US

IV. Provider business mailing address

41 CAMBELL SHORE RD
GRAY ME
04039-7770
US

V. Phone/Fax

Practice location:
  • Phone: 207-653-6680
  • Fax: 207-428-3925
Mailing address:
  • Phone: 207-653-6680
  • Fax: 207-428-3926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH2413
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: