Healthcare Provider Details

I. General information

NPI: 1417258591
Provider Name (Legal Business Name): CHEANA MARIE HERBEST RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2010
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 MEDFORD RD
MILO ME
04463-1519
US

IV. Provider business mailing address

337 MEDFORD RD
MILO ME
04463-1519
US

V. Phone/Fax

Practice location:
  • Phone: 207-943-3903
  • Fax:
Mailing address:
  • Phone: 207-943-3903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH3679
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: