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General NPI Number Information
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NPI Number | 1285027102
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Entity Type | Organization
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Legal Business Name | HEALTHY SMILES, LLC
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Dates
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Enumeration Date | 03/17/2015
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Last Update Date | 03/17/2015
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Provider Practice Location Address
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Address Line | 343 WATER ST
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City | GARDINER
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State | ME
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Zip | 04345-2160
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Country | US
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Telephone | 207-588-5526
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Fax |
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Provider Business Mailing Address
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Address Line | 343 WATER ST
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City | GARDINER
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State | ME
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Zip | 04345-2160
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Country | US
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Telephone | 207-588-5526
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ERIC SHAWN MCMASTER
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Credential | IPDH
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Telephone | 207-588-5526
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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 | IPDH54
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License Number State | ME
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