Provider Demographics
NPI:1760765523
Name:POOR, BELINDA JAN (RDH, BS)
Entity Type:Individual
Prefix:MRS
First Name:BELINDA
Middle Name:JAN
Last Name:POOR
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 UPTON RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:ME
Mailing Address - Zip Code:04216
Mailing Address - Country:US
Mailing Address - Phone:207-392-1166
Mailing Address - Fax:
Practice Address - Street 1:311 UPTON RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:ME
Practice Address - Zip Code:04216-6107
Practice Address - Country:US
Practice Address - Phone:207-392-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME704124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist