Provider Demographics
NPI:1710759543
Name:LEAVITT, MAUREEN LYNN (IPDH)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:LYNN
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:IPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04276
Mailing Address - Country:US
Mailing Address - Phone:207-974-3018
Mailing Address - Fax:207-507-1511
Practice Address - Street 1:60 LOWELL ST
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276
Practice Address - Country:US
Practice Address - Phone:207-974-3018
Practice Address - Fax:207-507-1511
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH2044124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist