Healthcare Provider Details

I. General information

NPI: 1588589774
Provider Name (Legal Business Name): L BOULET LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 SABATTUS RD STE 4
SABATTUS ME
04280-4021
US

IV. Provider business mailing address

17 MATOBIAN AVE
LEWISTON ME
04240-2229
US

V. Phone/Fax

Practice location:
  • Phone: 207-240-6662
  • Fax:
Mailing address:
  • Phone: 207-240-6662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. LISA BOULET
Title or Position: DENTAL HYGIENIST
Credential: RDH, IPDH
Phone: 207-240-6662