Provider Demographics
NPI:1023523438
Name:ROBILLARD, MARYELLEN (RDH)
Entity type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:
Last Name:ROBILLARD
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 1:159 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-1848
Mailing Address - Country:US
Mailing Address - Phone:781-826-4298
Mailing Address - Fax:
Practice Address - Street 1:4 KEITH WAY STE 3
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4258
Practice Address - Country:US
Practice Address - Phone:781-267-7627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH7954124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist