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General NPI Number Information
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NPI Number | 1669605325
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Entity Type | Individual
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Provider Name | LANA T INGALLS IPDH
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Gender | Female
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Dates
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Enumeration Date | 08/28/2009
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 1166 PORT ROAD
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City | MACHIASPORT
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State | ME
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Zip | 04655
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Country | US
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Telephone | 207-259-1129
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 34
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City | MACHIASPORT
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State | ME
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Zip | 04655-0034
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Country | US
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Telephone | 207-259-1129
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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 | IPH72
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License Number State | ME
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