Provider Demographics
NPI:1629328018
Name:OAKES, KELSY M (RDH)
Entity Type:Individual
Prefix:
First Name:KELSY
Middle Name:M
Last Name:OAKES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KELSY
Other - Middle Name:M
Other - Last Name:LAVERTU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-0099
Mailing Address - Country:US
Mailing Address - Phone:207-794-6700
Mailing Address - Fax:207-794-6777
Practice Address - Street 1:9 MAIN ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-1216
Practice Address - Country:US
Practice Address - Phone:207-794-6700
Practice Address - Fax:207-794-6777
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH3850124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist