=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922452721
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONA MACOMER DENTAL HYGIENIST RDH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2016
-----------------------------------------------------
Last Update Date | 04/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 WINTER ST
-----------------------------------------------------
City | DOVER FOXCROFT
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04426-1022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-564-3455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 426
-----------------------------------------------------
City | DOVER FOXCROFT
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04426-0426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-607-9374
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 2624
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------