Provider Demographics
NPI:1760789044
Name:BRIDGTON DENTAL HYGIENE CARE, PA
Entity Type:Organization
Organization Name:BRIDGTON DENTAL HYGIENE CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KASPRAK
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, IPDH
Authorized Official - Phone:207-647-4125
Mailing Address - Street 1:171-B PORTLAND RD.
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-4210
Mailing Address - Country:US
Mailing Address - Phone:207-647-4125
Mailing Address - Fax:207-647-4126
Practice Address - Street 1:171-B PORTLAND RD.
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-4210
Practice Address - Country:US
Practice Address - Phone:207-647-4125
Practice Address - Fax:207-647-4126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEIPDH8124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty