Provider Demographics
NPI:1700851714
Name:SMITH-BOUCHARD, SHARON (RDH)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:SMITH-BOUCHARD
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 1:117 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRONG
Mailing Address - State:ME
Mailing Address - Zip Code:04983
Mailing Address - Country:US
Mailing Address - Phone:207-684-3045
Mailing Address - Fax:207-684-3049
Practice Address - Street 1:117 N MAIN ST
Practice Address - Street 2:
Practice Address - City:STRONG
Practice Address - State:ME
Practice Address - Zip Code:04983
Practice Address - Country:US
Practice Address - Phone:207-684-3045
Practice Address - Fax:207-684-3049
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2274124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist