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General NPI Number Information
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NPI Number | 1811230790
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Entity Type | Organization
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Legal Business Name | HEALTHY MAINE SMILES
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Dates
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Enumeration Date | 03/29/2013
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Last Update Date | 03/29/2013
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Provider Practice Location Address
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Address Line | 175 FERRY RD
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City | LEWISTON
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State | ME
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Zip | 04240-1101
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Country | US
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Telephone | 207-241-3313
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Fax |
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Provider Business Mailing Address
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Address Line | 175 FERRY RD
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City | LEWISTON
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State | ME
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Zip | 04240-1101
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Country | US
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Telephone | 207-241-3313
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Fax |
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Authorized Official
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Title or Position | INDEPENDENT DENTAL HYGIENIST
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Name | MRS. JENNIFER LYNN BELANGER
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Credential | IPDH
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Telephone | 207-576-2655
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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 | IPH58
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License Number State | ME
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