Healthcare Provider Details

I. General information

NPI: 1003851031
Provider Name (Legal Business Name): NANCY BOYD BEARS IPDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SUMMER ST
MILLINOCKET ME
04462-1400
US

IV. Provider business mailing address

PO BOX 500
PATTEN ME
04765-0500
US

V. Phone/Fax

Practice location:
  • Phone: 207-723-6551
  • Fax: 207-723-6564
Mailing address:
  • Phone: 207-528-2285
  • Fax: 207-528-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberIPH98
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: