Healthcare Provider Details

I. General information

NPI: 1174083091
Provider Name (Legal Business Name): JESSICA MARY GELLAR-COTE RDH, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 STEVENS AVE
PORTLAND ME
04103-2656
US

IV. Provider business mailing address

2 INNKEEPERS LN
FALMOUTH ME
04105-2530
US

V. Phone/Fax

Practice location:
  • Phone: 207-221-4875
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH3569
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: