Healthcare Provider Details

I. General information

NPI: 1659330447
Provider Name (Legal Business Name): TIMOTHY WAYNE ARCHER RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MAIN ST
LINCOLN ME
04457-1216
US

IV. Provider business mailing address

PO BOX 99
LINCOLN ME
04457-0099
US

V. Phone/Fax

Practice location:
  • Phone: 207-794-8790
  • Fax: 207-794-6777
Mailing address:
  • Phone: 207-794-6700
  • Fax: 207-794-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3002
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: