Provider Demographics
NPI:1235397647
Name:REMINGTON, MARY BARTLETT (REGISTERED DENTAL HY)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:BARTLETT
Last Name:REMINGTON
Suffix:
Gender:F
Credentials:REGISTERED DENTAL HY
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:BARTLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED DENTAL HY
Mailing Address - Street 1:20 PORTLAND STREET
Mailing Address - Street 2:HEALTHCARE FOR THE HOMELESS DENTAL CLINIC
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2912
Mailing Address - Country:US
Mailing Address - Phone:207-874-8983
Mailing Address - Fax:
Practice Address - Street 1:20 PORTLAND STREET
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2912
Practice Address - Country:US
Practice Address - Phone:207-874-8450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1082124Q00000X
NH00468124Q00000X
OHDH3854124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432757599Medicaid