Provider Demographics
NPI:1922371814
Name:PIKE, BONNIE ELLISH (IPDH)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:ELLISH
Last Name:PIKE
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:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:ME
Mailing Address - Zip Code:04001-0155
Mailing Address - Country:US
Mailing Address - Phone:603-520-4136
Mailing Address - Fax:
Practice Address - Street 1:2 YOUNGS RIDGE RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:ME
Practice Address - Zip Code:04001-6616
Practice Address - Country:US
Practice Address - Phone:603-520-4136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEIPH44124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist