Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | RDH3994 | ME |
NPI | 1033507066 |
---|---|
Provider Name | Janean Jones |
First Address | Westport Island, ME 04578-3303 |
Second Address | Lewiston, ME 04240-5903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2014 |
Last Update Date | 29/12/2014 |