Provider Demographics
NPI:1982913216
Name:POULIN, DONNA L (RDH)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:POULIN
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 1:41 CAMBELL SHORE RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-7770
Mailing Address - Country:US
Mailing Address - Phone:207-653-6680
Mailing Address - Fax:207-428-3926
Practice Address - Street 1:41 CAMBELL SHORE RD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039-7770
Practice Address - Country:US
Practice Address - Phone:207-653-6680
Practice Address - Fax:207-428-3925
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH2413124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MERDH2413OtherMAINE