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General NPI Number Information
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NPI Number | 1306220868
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Entity Type | Individual
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Provider Name | MARIE CHARLENE LOUISGENE
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Gender | Female
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 08/25/2017
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Provider Practice Location Address
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Address Line | 25 ARLMONT STREET
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City | MILFORD
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State | CT
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Zip | 06461
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Country | US
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Telephone | 203-278-9143
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Fax |
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Provider Business Mailing Address
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Address Line | 25 ARLMONT ST
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City | MILFORD
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State | CT
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Zip | 06461-2903
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Country | US
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Telephone | 203-892-7008
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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 | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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