Healthcare Provider Details

I. General information

NPI: 1629488291
Provider Name (Legal Business Name): ASHLEE MADDONALD RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MAIN ST SUITE B
LINCOLN ME
04457-1216
US

IV. Provider business mailing address

PO BOX 99
LINCOLN ME
04457-0099
US

V. Phone/Fax

Practice location:
  • Phone: 207-794-6700
  • Fax:
Mailing address:
  • Phone: 207-794-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3015
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: