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General NPI Number Information
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NPI Number | 1114433091
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Entity Type | Individual
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Provider Name | AMANDA ROSE JORDAN RDH
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Gender | Female
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Dates
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Enumeration Date | 12/14/2017
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Last Update Date | 12/14/2017
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Provider Practice Location Address
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Address Line | 19 PETTINGILL ST
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City | LEWISTON
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State | ME
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Zip | 04240-5903
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Country | US
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Telephone | 207-513-1111
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Fax | 207-513-1197
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Provider Business Mailing Address
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Address Line | 269 HEBRON RD
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City | BUCKFIELD
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State | ME
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Zip | 04220-4136
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Country | US
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Telephone | 207-740-4170
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | RDH4147
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License Number State | ME
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