Provider Demographics
NPI:1942728332
Name:CHANCELLOR, MACKENZIE ERIN (RDH)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:ERIN
Last Name:CHANCELLOR
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 LOWELLTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WISCASSET
Mailing Address - State:ME
Mailing Address - Zip Code:04578-4417
Mailing Address - Country:US
Mailing Address - Phone:207-653-8170
Mailing Address - Fax:
Practice Address - Street 1:186 LOWELLTOWN RD
Practice Address - Street 2:
Practice Address - City:WISCASSET
Practice Address - State:ME
Practice Address - Zip Code:04578
Practice Address - Country:US
Practice Address - Phone:207-653-8170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH4145124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist