Provider Demographics
NPI:1760534325
Name:THIBODEAU, HARROLD JOSEPH JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:HARROLD
Middle Name:JOSEPH
Last Name:THIBODEAU
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:H
Other - Middle Name:JOSEPH
Other - Last Name:THIBODEAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:97 LEE RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457
Mailing Address - Country:US
Mailing Address - Phone:207-794-6896
Mailing Address - Fax:207-794-0200
Practice Address - Street 1:97 LEE RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457
Practice Address - Country:US
Practice Address - Phone:207-794-6896
Practice Address - Fax:207-794-0200
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist