Provider Demographics
NPI:1811230790
Name:HEALTHY MAINE SMILES
Entity Type:Organization
Organization Name:HEALTHY MAINE SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT DENTAL HYGIENIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BELANGER
Authorized Official - Suffix:
Authorized Official - Credentials:IPDH
Authorized Official - Phone:207-576-2655
Mailing Address - Street 1:175 FERRY RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-1101
Mailing Address - Country:US
Mailing Address - Phone:207-241-3313
Mailing Address - Fax:
Practice Address - Street 1:175 FERRY RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-1101
Practice Address - Country:US
Practice Address - Phone:207-241-3313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEIPH58124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty