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NPI Code Detail

MEDICARE: MRS. MARY ELIZABETH AUBE RDH, MS ED

MEDICARE: MRS. MARY ELIZABETH AUBE RDH, MS ED
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 HygienistRDH2333ME

General Provider Information

NPI Number : 1932681871
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY ELIZABETH AUBE RDH, MS ED
Provider Business Mailing Address
First Line : 716 STEVENS AVE
Second Line :
City : PORTLAND
State : ME
Zip : 04103-2656
Country : US
Telephone Number : 207-415-5860
Fax Number :
Provider Business Practice Location Address
First Line : 716 STEVENS AVE
Second Line :
City : PORTLAND
State : ME
Zip : 04103-2693
Country : US
Telephone Number : 207-415-5860
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2018
Last Update Date : 09/06/2018

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