Provider Demographics
NPI:1407426307
Name:RIDEOUT PREVENTATIVE DENTAL
Entity Type:Organization
Organization Name:RIDEOUT PREVENTATIVE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDEOUT
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:207-876-6988
Mailing Address - Street 1:152 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1254
Mailing Address - Country:US
Mailing Address - Phone:207-876-6988
Mailing Address - Fax:
Practice Address - Street 1:859 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1020
Practice Address - Country:US
Practice Address - Phone:207-876-6988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty