Healthcare Provider Details

I. General information

NPI: 1467594549
Provider Name (Legal Business Name): CHRISTI L STEVENS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 N. MAIN ST
STRONG ME
04983
US

IV. Provider business mailing address

42 DALLAS HILL RD PO BOX 569
RANGELEY ME
04970-0569
US

V. Phone/Fax

Practice location:
  • Phone: 207-684-3045
  • Fax:
Mailing address:
  • Phone: 207-864-3303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2998
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: