MEDICARE: CARLA NEWCOMB 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	2060	ME

General Provider Information

NPI Number	:	1639313687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA NEWCOMB RDH

Provider Business Mailing Address
First Line	:	464 BENTON AVE
Second Line	:
City	:	WINSLOW
State	:	ME
Zip	:	04901-3015
Country	:	US
Telephone Number	:	207-872-7833
Fax Number	:	207-873-0036

Provider Business Practice Location Address
First Line	:	464 BENTON AVE
Second Line	:
City	:	WINSLOW
State	:	ME
Zip	:	04901-3015
Country	:	US
Telephone Number	:	207-872-7833
Fax Number	:	207-873-0036

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

Provider Enumeration Date	:	04/21/2009
Last Update Date	:	04/21/2009

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Directions to “ CARLA NEWCOMB RDH” Practice Location

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