Healthcare Provider Details

I. General information

NPI: 1386871507
Provider Name (Legal Business Name): CHERYL LYNNE SKILLING REGISTERED DENTAL HY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 GARDINER ST.
RICHMOND ME
04357
US

IV. Provider business mailing address

460 NORTH RAYMOND RD
POLAND ME
04274
US

V. Phone/Fax

Practice location:
  • Phone: 207-737-2099
  • Fax:
Mailing address:
  • Phone: 207-737-2099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2160
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: