Healthcare Provider Details

I. General information

NPI: 1417861352
Provider Name (Legal Business Name): AMBER R BERUBE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 GARDINER RD STE 2
WALES ME
04280-3257
US

IV. Provider business mailing address

100 GRANT RD
LITCHFIELD ME
04350-3347
US

V. Phone/Fax

Practice location:
  • Phone: 207-375-3016
  • Fax:
Mailing address:
  • Phone: 207-375-3016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH3866
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: