Provider Demographics
NPI:1639909922
Name:SERENE DENTAL HYGIENE LLC
Entity type:Organization
Organization Name:SERENE DENTAL HYGIENE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IPDH
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:IPDH
Authorized Official - Phone:207-214-3145
Mailing Address - Street 1:29 STONEYBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:HERMON
Mailing Address - State:ME
Mailing Address - Zip Code:04401-0553
Mailing Address - Country:US
Mailing Address - Phone:207-214-3145
Mailing Address - Fax:
Practice Address - Street 1:16 GROVE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5310
Practice Address - Country:US
Practice Address - Phone:207-214-3145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty