MEDICARE: JEAN L'ITALIEN 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	2072	ME

General Provider Information

NPI Number	:	1972562866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN L'ITALIEN RDH

Provider Business Mailing Address
First Line	:	PO BOX 99
Second Line	:
City	:	LINCOLN
State	:	ME
Zip	:	04457-0099
Country	:	US
Telephone Number	:	207-794-6700
Fax Number	:	207-794-6777

Provider Business Practice Location Address
First Line	:	9 MAIN ST
Second Line	:	RUHL BUILDING
City	:	LINCOLN
State	:	ME
Zip	:	04457-1216
Country	:	US
Telephone Number	:	207-794-6700
Fax Number	:	207-794-8792

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	07/08/2007

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