Provider Demographics
NPI:1942435243
Name:DOHERTY, ELIZABETH MAHAR (RDH)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MAHAR
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:MAHAR
Other - Last Name:DOHERTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:131 MAIN ST
Mailing Address - Street 2:MAIN STREET DENTAL HYGIENE
Mailing Address - City:MEXICO
Mailing Address - State:ME
Mailing Address - Zip Code:04257-1412
Mailing Address - Country:US
Mailing Address - Phone:207-364-1480
Mailing Address - Fax:
Practice Address - Street 1:131 MAIN ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:ME
Practice Address - Zip Code:04257-1412
Practice Address - Country:US
Practice Address - Phone:207-364-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-16
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME943124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist