Healthcare Provider Details

I. General information

NPI: 1710808209
Provider Name (Legal Business Name): MRS. MELISSA MARIE VINING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 KIMBALL POND RD
NEW SHARON ME
04955
US

IV. Provider business mailing address

93 OLDE FERRY RD
STARKS ME
04911-4745
US

V. Phone/Fax

Practice location:
  • Phone: 207-500-0454
  • Fax:
Mailing address:
  • Phone: 207-612-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH2597
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: