Healthcare Provider Details

I. General information

NPI: 1023665239
Provider Name (Legal Business Name): LILY A YOUNG RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SUMMER ST
MILLINOCKET ME
04462-1400
US

IV. Provider business mailing address

529 S PATTEN RD
PATTEN ME
04765-3007
US

V. Phone/Fax

Practice location:
  • Phone: 207-538-3700
  • Fax: 207-521-0066
Mailing address:
  • Phone: 207-538-3700
  • Fax: 207-528-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH4227
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: