Provider Demographics
NPI:1427596170
Name:QUALEY, CYNTHIA (RDH)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:QUALEY
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 1:529 S PATTEN RD
Mailing Address - Street 2:
Mailing Address - City:PATTEN
Mailing Address - State:ME
Mailing Address - Zip Code:04765-3007
Mailing Address - Country:US
Mailing Address - Phone:207-528-2285
Mailing Address - Fax:207-528-2880
Practice Address - Street 1:30 HOULTON ST
Practice Address - Street 2:
Practice Address - City:PATTEN
Practice Address - State:ME
Practice Address - Zip Code:04765-3035
Practice Address - Country:US
Practice Address - Phone:207-528-2285
Practice Address - Fax:207-528-2880
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH953124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist