Provider Demographics
NPI:1376832253
Name:SMITH, JEANNIE D (RDH)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:D
Last Name:SMITH
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:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-0311
Mailing Address - Country:US
Mailing Address - Phone:207-255-3426
Mailing Address - Fax:207-255-3661
Practice Address - Street 1:14 STEVES LANE
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:ME
Practice Address - Zip Code:04654
Practice Address - Country:US
Practice Address - Phone:207-255-3426
Practice Address - Fax:207-255-3661
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH2297124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist