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NPI Code Detail

MEDICARE: MARIA POWELL RDH

MEDICARE: MARIA POWELL 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
1124Q00000XDental HygienistDH26321FL

General Provider Information

NPI Number : 1730663253
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA POWELL RDH
Provider Business Mailing Address
First Line : 800 E MERRITT ISLAND CSWY
Second Line :
City : MERRITT ISLAND
State : FL
Zip : 32952-3514
Country : US
Telephone Number : 321-505-8869
Fax Number :
Provider Business Practice Location Address
First Line : 800 E MERRITT ISLAND CSWY
Second Line :
City : MERRITT ISLAND
State : FL
Zip : 32952-3514
Country : US
Telephone Number : 321-453-8882
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2018
Last Update Date : 09/20/2018

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