MEDICARE: CHAUNA OAK 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	RDH4301	ME

General Provider Information

NPI Number	:	1740047620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAUNA OAK RDH

Provider Business Mailing Address
First Line	:	6 MIDDLE ST
Second Line	:
City	:	BIDDEFORD
State	:	ME
Zip	:	04005-3409
Country	:	US
Telephone Number	:	207-651-1631
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 SPRUCE ST
Second Line	:
City	:	SANFORD
State	:	ME
Zip	:	04073-2917
Country	:	US
Telephone Number	:	207-651-1631
Fax Number	:

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

Provider Enumeration Date	:	03/06/2024
Last Update Date	:	03/22/2024

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Directions to “ CHAUNA OAK RDH” Practice Location

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