MEDICARE: KELSY M OAKES RDH

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	RDH3850	ME

General Provider Information

NPI Number	:	1629328018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSY M OAKES RDH

Provider Business Mailing Address
First Line	:	PO BOX 99
Second Line	:
City	:	LINCOLN
State	:	ME
Zip	:	04457-0099
Country	:	US
Telephone Number	:	207-794-6700
Fax Number	:	207-794-6777

Provider Business Practice Location Address
First Line	:	9 MAIN ST
Second Line	:
City	:	LINCOLN
State	:	ME
Zip	:	04457-1216
Country	:	US
Telephone Number	:	207-794-6700
Fax Number	:	207-794-6777

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

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	06/11/2014

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