Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | RDH3624 | ME |
NPI | 1083066104 |
---|---|
Provider Name | Ashley Cyr |
First Address | Presque Isle, ME 04769-3005 |
Second Address | Presque Isle, ME 04769-3005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2016 |
Last Update Date | 13/07/2016 |