Provider Demographics
NPI:1194013136
Name:BRETON, NICOLE M (RDH)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:M
Last Name:BRETON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ALBION RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:ME
Mailing Address - Zip Code:04901-2817
Mailing Address - Country:US
Mailing Address - Phone:207-287-3263
Mailing Address - Fax:207-287-7213
Practice Address - Street 1:800 ALBION RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:ME
Practice Address - Zip Code:04901-2817
Practice Address - Country:US
Practice Address - Phone:207-287-3263
Practice Address - Fax:207-287-7213
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2808124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist