MEDICARE: MARIAH BRETON 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	4189	ME

General Provider Information

NPI Number	:	1720679707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH BRETON RDH

Provider Business Mailing Address
First Line	:	66A GOULD RD
Second Line	:
City	:	LISBON FALLS
State	:	ME
Zip	:	04252-9758
Country	:	US
Telephone Number	:	207-212-7677
Fax Number	:

Provider Business Practice Location Address
First Line	:	568 LISBON ST
Second Line	:
City	:	LISBON FALLS
State	:	ME
Zip	:	04252-1138
Country	:	US
Telephone Number	:	207-212-7677
Fax Number	:

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

Provider Enumeration Date	:	02/01/2021
Last Update Date	:	02/01/2021

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Directions to “ MARIAH BRETON RDH” Practice Location

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