Provider Demographics
NPI:1578630778
Name:CHOUINARD, TAMMY (RDH)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:CHOUINARD
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 569
Mailing Address - Street 2:42 DALLAS HILL RD
Mailing Address - City:RANGELEY
Mailing Address - State:ME
Mailing Address - Zip Code:04970-0569
Mailing Address - Country:US
Mailing Address - Phone:207-864-3303
Mailing Address - Fax:207-864-2969
Practice Address - Street 1:177 N MAIN ST
Practice Address - Street 2:
Practice Address - City:STRONG
Practice Address - State:ME
Practice Address - Zip Code:04983-3005
Practice Address - Country:US
Practice Address - Phone:207-684-3045
Practice Address - Fax:207-684-3049
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2723124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2723OtherHYGIENIST LICENSE