Provider Demographics
NPI:1376952762
Name:ORCHARDSIDE DENTAL HYGIENE LLC
Entity Type:Organization
Organization Name:ORCHARDSIDE DENTAL HYGIENE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:IPDH
Authorized Official - Phone:207-703-3339
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:ME
Mailing Address - Zip Code:04001-0048
Mailing Address - Country:US
Mailing Address - Phone:207-703-3339
Mailing Address - Fax:
Practice Address - Street 1:1881 RT. 109
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:ME
Practice Address - Zip Code:04001
Practice Address - Country:US
Practice Address - Phone:207-703-3339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty