MEDICARE: JILL FARLEY IPDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	IPDH41	ME

General Provider Information

NPI Number	:	1184964660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL FARLEY IPDH

Provider Business Mailing Address
First Line	:	3 SCHOPPEE DR
Second Line	:
City	:	OLD ORCHARD BEACH
State	:	ME
Zip	:	04064-1428
Country	:	US
Telephone Number	:	207-205-2568
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 SCHOPPEE DR
Second Line	:
City	:	OLD ORCHARD BEACH
State	:	ME
Zip	:	04064-1428
Country	:	US
Telephone Number	:	207-205-2568
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2013
Last Update Date	:	02/21/2013

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