Provider Demographics
NPI:1003668195
Name:MID MAINE DENTAL HYGIENE LLC
Entity Type:Organization
Organization Name:MID MAINE DENTAL HYGIENE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RDH
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:IPDH
Authorized Official - Phone:207-881-7069
Mailing Address - Street 1:2043 DEXTER RD
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-4009
Mailing Address - Country:US
Mailing Address - Phone:207-279-0626
Mailing Address - Fax:
Practice Address - Street 1:45 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MILO
Practice Address - State:ME
Practice Address - Zip Code:04463-1024
Practice Address - Country:US
Practice Address - Phone:207-881-7069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental