Healthcare Provider Details

I. General information

NPI: 1942435243
Provider Name (Legal Business Name): ELIZABETH MAHAR DOHERTY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA MAHAR DOHERTY RDH

II. Dates (important events)

Enumeration Date: 05/16/2009
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MAIN ST
MEXICO ME
04257-1412
US

IV. Provider business mailing address

131 MAIN ST MAIN STREET DENTAL HYGIENE
MEXICO ME
04257-1412
US

V. Phone/Fax

Practice location:
  • Phone: 207-364-1480
  • Fax:
Mailing address:
  • Phone: 207-364-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number943
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: