Provider Demographics
NPI:1720679707
Name:BRETON, MARIAH (RDH)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:BRETON
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 1:66A GOULD RD
Mailing Address - Street 2:
Mailing Address - City:LISBON FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04252-9758
Mailing Address - Country:US
Mailing Address - Phone:207-212-7677
Mailing Address - Fax:
Practice Address - Street 1:568 LISBON ST
Practice Address - Street 2:
Practice Address - City:LISBON FALLS
Practice Address - State:ME
Practice Address - Zip Code:04252-1138
Practice Address - Country:US
Practice Address - Phone:207-212-7677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME4189124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist