Healthcare Provider Details

I. General information

NPI: 1093627820
Provider Name (Legal Business Name): UP NORTH DENTAL HYGIENE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 MAIN ST STE 4
VAN BUREN ME
04785-1518
US

IV. Provider business mailing address

254 MARQUIS RD
VAN BUREN ME
04785-1717
US

V. Phone/Fax

Practice location:
  • Phone: 207-496-8978
  • Fax: 207-496-8978
Mailing address:
  • Phone: 207-496-8978
  • Fax: 207-496-8978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HALEY ANN AYOTTE
Title or Position: DENTAL HYGIENIST
Credential: IPDH
Phone: 207-493-0857