Healthcare Provider Details

I. General information

NPI: 1770373615
Provider Name (Legal Business Name): ELIZABETH J CUSHING RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WESTMINSTER ST # 04240
LEWISTON ME
04240-3531
US

IV. Provider business mailing address

40 WALKER RD
READFIELD ME
04355-3755
US

V. Phone/Fax

Practice location:
  • Phone: 207-513-1111
  • Fax:
Mailing address:
  • Phone: 207-707-0540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number4580
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: