Provider Demographics
NPI:1093940983
Name:JOWETT, TRACEY L (RDH, BSDH, IPDH)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:L
Last Name:JOWETT
Suffix:
Gender:F
Credentials:RDH, BSDH, IPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:ME
Mailing Address - Zip Code:04363-3737
Mailing Address - Country:US
Mailing Address - Phone:207-445-2852
Mailing Address - Fax:
Practice Address - Street 1:28 SMITH RD
Practice Address - Street 2:SUITE #1
Practice Address - City:WINDSOR
Practice Address - State:ME
Practice Address - Zip Code:04363-3737
Practice Address - Country:US
Practice Address - Phone:207-445-2852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEIPH61124Q00000X
MERDH2532124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431944500Medicaid