Healthcare Provider Details

I. General information

NPI: 1255530028
Provider Name (Legal Business Name): SARAH E FISKE DENTAL ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
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: 207-723-6565
  • Fax: 207-723-6564
Mailing address:
  • Phone: 207-723-6565
  • Fax: 207-723-6564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: